Duloxetine use in painful conditions

Introduction: Antidepressants offer substantial analgesic benefits for a wide range of chronic pain conditions. Areas covered: The serotonin-norepinephrine reuptake inhibitor, duloxetine, is well established for reducing pain in patients with diabetic neuropathy and fibromyalgia. Indications were recently expanded also to include the treatment of chronic musculoskeletal pain related to osteoarthritis and chronic low back pain. In addition, animal studies and postoperative pain data indicate possible additional uses of duloxetine for the management of acute pain. Expert opinion: Antidepressants, such as duloxetine, offer a valuable therapy for patients with chronic pain, regardless of whether comorbid mood disorders are present or not. Clinicians must set reasonable expectations for anticipated improvements with duloxetine. In general, a 30% improvement in average nonmalignant pain severity represents a clinically meaningful improvement target. About 50 - 60% of patients with chronic osteoarthritis or chronic low back pain treated with 60 - 120 mg duloxetine daily can expect this level of improvement.