Case Report: Oral Fluphenazine for Treatment of Chronic Sacral Pain

Management of chronic pain syndromes represent significant challenges to clinicians. Fluphenazine was shown to attenuate mechanical allodynia in rat neuropathic pain models via antagonism of voltage gated sodium channels and has been identified as a candidate drug for chronic pain. We present a 66 year old man with treatment-refractory chronic pain syndrome. Right ischial pain developed over time as a result of his years practicing as a dentist sitting on a stool with a tilted seat pan. Imaging and neurologic investigations led to a presumed diagnosis of chronic microtears of the sacrotuberous ligament. The patient failed to respond to multiple modes of therapy. Prescribed medications included amitriptyline, celecoxib, duloxetine, gabapentin, muscle relaxants, opioids, and quetiapine. Procedures included facet and trigger point injections, platelet-rich plasma injections, and prolotherapy. Nonpharmacologic modalities included acupuncture, chiropractic therapy, osteopathic manipulation therapy, physical therapy, and psychotherapy. He then underwent an outpatient, nine-month course of oral fluphenazine, in which his pain was controlled successfully, resulting in resumption of normal sleep and daily activities per the patient. This case suggests fluphenazine as a monotherapy for refractory chronic pain.