Clinical Medicine Reviews in Therapeutics

Chronic pain represents one of the most important public health problems and, in addition to classical analgesics, antidepressants are an essential part of therapeutic management. This is due to the regulation of pain signals in the central nervous system and the spinal cord by serotonin and noradrenaline. As the role of serotonin and noradrenaline in the modulation of pain perception has become better understood, serotonin and noradrenaline reuptake inhibitors—including duloxetine—have been assessed in terms of their therapeutic values as analgesics. Several randomized, double-blind, controlled trials have led to duloxetine’s approval in the treatment of diabetic

peripheral neuropathic pain as well as in the management of fibromyalgia.

The superiority of duloxetine over placebo was shown, while comparison studies with other antidepressants showed only partly superiority. Duloxetine has been found to be safe and well tolerable, with mild-to-moderate adverse events, a favourable cardiovascular profile, and minor influence on weight gain. A beneficial influence on the quality of life and well-being could be widely shown. First results indicate that duloxetine might also be effective in other pain states such as lower back pain, osteoarthritis, migraine and also in the treatment of children with depression and pain.