Vitas Healthcare | USA
Brittney Katsoff, M.D., completed her university training at University of Pennsylvania receive an AB degree (major psychology). She received an M.D. degree from Robert Wood Johnson Medical School. She completed her residency in internal medicine at Temple University School of Medicine and is board certified in internal medicine. She completed her fellowship in Hospice and Palliative Medicine at Drexel University Medical School and is board certified in that specialty. She is the lead or co-author of 45 peer reviewed manuscripts. She is currently working as a specialist in hospice and palliative medicine for Vitas.
Statement of problem: Dextroamphetamine sulfate has many years provided marked relief of pain from a variety of disorders that failed to respond to conventional therapy including, but not limited to, headaches, pelvic pain, interstitial cystitis, fibromyalgia, abdominal pain associated with motility disorders, or inflammatory bowel disease, and rheumatoid arthritis. The present study evaluated the benefits vs. side effects in an 88 year old man suffering from such severe post-herpetic neuralgia over a 5-year duration that he was investigating whether there are any doctors or clinics available where assisted suicide is performed. The patient had failed to improve following treatment with gabapentin, pregabalin, and duloxetine and had marginal relief from lidocaine patches, hydrocodine, oxycodone (all caused nausea), acupuncture and TENS unit.
Findings: The patient was started on dextroamphetamine sulfate 15mg extended release capsule daily starting at age 88 (after 5 years of no relief from left sided flank pain extending to the back same area as herpes infection). His dosage was increased to 30mg which provided 90% relief of pain within 2 months of treatment. The relief lasted 5 years with daily treatment. He died peacefully while sleeping at age 93 pain free for 5 years.
Conclusions: This very elderly man had no side effects from treatment with dextroamphetamine sulfate. The drug is believed to provide amelioration of pain by stimulating the release of dopamine from sympathetic nerve fibers. This biogenic amine function to inhibit cellular permeability. Excess absorption of irritants into the tissues may lead to excessive inflammation leading to pain. Palliative care specialists should be aware of the benefits of sympathomimetic amine therapy for pain even for people in their late 80’s or 90’s.