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Refractory pain in a schizophrenic patient on clozapine
  1. Edgar Asiimwe1,
  2. Emily DeFraites2 and
  3. Csilla Feher3
  1. 1Department of Internal Medicine, UCLA, Los Angeles, California, USA
  2. 2Department of Psychiatry, UCLA, Los Angeles, California, USA
  3. 3Psychiatry, Department of Veterans Affairs Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Edgar Asiimwe; easiimwe{at}


A 36-year-old man with schizophrenia, on two times per day clozapine, presented with a 2-year history of diffuse intermittent body pain.

Per chart review—and on presentation—his physical examination had been consistently unremarkable, without point-tenderness elicited at any major muscle groups or focal neurological deficits. Workup for myopathy, neuropathy and supratherapeutic clozapine levels had similarly been unrevealing.

Given that prior interventions had been unsuccessful in alleviating these symptoms, we queried whether clozapine might have been contributory. As a result, we adopted a previously described strategy of scheduling the bulk of patients’ medication during non-waking hours.

At 1-month follow-up, the patient reported about a 50% improvement in his symptoms. At 6-month follow-up, this improvement in symptoms had been sustained.

Our findings add to the limited anecdotal reports of this side effect whose true prevalence remains unknown. Timely recognition has the potential to promote adherence to therapy among patients in the maintenance phase.

  • schizophrenia
  • drugs: psychiatry

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  • Contributors EA drafted the manuscript and provided primary care to the patient. ED is the patient’s psychiatrist and collaborated with EA to advance care and supervised the manuscript’s comiplation. CF facilitated patient care and provided advise on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.