Standard dose of duloxetine effective for managing chronic pain in adults
A study published in the Cochrane Database of Systematic Reviews entitled "Antidepressants for pain management in adults with chronic pain: a network meta‐analysis has concluded that Duloxetine, an antidepressant, has a moderate effect on reducing chronic pain. They elaborated, saying the higher doses of Duloxetine have no extra benefits than standard doses. They added details on data mentioning, "For every 1000 people taking duloxetine in a standard dose, 435 will experience 50% pain relief than 287 who will experience 50% pain relief taking placebo."
They also said, "Milnacipran may reduce pain, but we are not as confident in this result."
It is already known that Chronic pain lasts for more than three months and affects people's mood and well‐being. It hampers one's ability to perform routine tasks and is common among adults. Overall adversely impacts physical ability, well‐being, and quality of life. Researchers in previous studies have stated that certain antidepressants may effectively reduce pain. They can also be beneficial about improvement in patients' global impression of change for chronic pain conditions. There needs to be more research and data on the role of antidepressants on this subject.
Researchers in this study assessed the comparative efficacy and safety of antidepressants. They included adults with chronic pain except for headaches and researched databases. The RCTs examined antidepressants for chronic pain against any comparator.
The primary outcomes measured were substantial (50%) pain relief, pain intensity, mood, and adverse events.
Moderate pain relief by 30%, physical function, sleep, quality of life, Patient Global Impression of Change or PGIC, serious adverse events, and withdrawal were the secondary outcomes measured.
The study results are:
- One hundred seventy-six studies were included, with a total of 28,664 participants.
- The common pain conditions examined were fibromyalgia, neuropathic pain and musculoskeletal pain.
- RCT had an average length of 10 weeks.
- No data was obtained from the seven studies
- Regarding efficacy, Duloxetine was the highest‐ranked antidepressant with moderate‐ to high‐certainty evidence.
- Milnacipran was ranked the next most efficacious antidepressant, but the certainty of the evidence was lower compared to Duloxetine.
- Duloxetine in a standard dose of 60 mg presented a small to moderate effect for substantial pain relief.
- 30 mg Mirtazapine had a moderate effect on mood.
They said, "We are only confident in the effectiveness of one antidepressant: duloxetine which in standard dose (60 mg) was effective. There is no benefit in using a higher dose."
We wanted to determine if antidepressants were effective for managing chronic pain and whether they are associated with unwanted effects.
The study's limitations were related to a lack of data on other antidepressants aside from Duloxetine and milnacipran, a lack of information on long-term results, no reliable evidence on the safety of taking antidepressants and a lack of information related to the degree of effectiveness for people with both chronic pain and depression.
Further reading:
Birkinshaw H et al. Antidepressants for pain management in adults with chronic pain: a network meta‐analysis. Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD014682. DOI: 10.1002/14651858.CD014682.pub2.
