Effect Of Duloxetine Research Articles

DULOXETINE HYDROCHLORIDE INDUCED PARESTHESIA - A CASE REPORT

A 45-year-old HIV-positive female patient experienced a generalized burning sensation after the administration of one dose of duloxetine 20 mg. The patient’s concurrent medications include a fixed drug combination of nevirapine 200 mg, Lamivudine 150 mg, and Zidovudine 300 mg, twice daily for 5 years. The patient recovered from the generalized burning sensation the next day after the withdrawal of duloxetine. From the causal relationship assessment, we observed that neither the disease, comorbid conditions, nor concurrent medications were found responsible for the burning sensation experience in this patient. Available data from post-marketing surveillance of duloxetine suggest that to date the incidence of duloxetine-induced burning sensation of skin was reported to be 1 in 870 patients. Health-care providers should watch for this rare but important adverse effect of duloxetine.

A randomized, double-blinded, placebo-controlled clinical trial of duloxetine hydrochloride enteric-coated tablets in the treatment of refractory chronic cough

IntroductionRefractory cough, a chronic cough with an unclear diagnosis or poor treatment response. The symptoms are often stubborn and persistent, causing serious complications and lowering the patient's quality of life. Cough hypersensitivity syndrome (CHS) is proposed as a potential cause, and reducing sensory nerve hyperresponsiveness is suggested as an effective treatment. However, current drugs have low efficacy and benefit rates and numerous side effects. This trail proposes using duloxetine, a selective 5-HT and norepinephrine reuptake inhibitor, as a potential treatment for refractory cough, which has shown promise in treating pain and depression. Duloxetine may inhibit pain conduction and oxidative stress in peripheral nerves by inhibiting the activity of TRPV1 channels, which play an important role in the peripheral afferent pathway of refractory cough. Meanwhile, the antidepressant effects of duloxetine may also play a role in the treatment of refractory cough.Methods and analysisThis is a single-center, prospective, randomized, double-blind, and controlled trial. A total of 98 individuals will be randomized in a 1:1 ratio to duloxetine group and placebo control group (starting with 20 mg QD, increasing 20 mg daily until 20 mg TID). After a screening period, the second stage runs from baseline to the 42nd (last) day of treatment, with follow-up visits on the 3rd, 7th, 14th, 21st, 28th, 35th, 42nd and 49th days. The main end-stage observation indicators include objective cough frequency, cough visual analog scale (VAS), cough symptom score, Leicester Cough Questionnaire (LCQ), and cough evaluation test (CET); the secondary end-stage observation indicators include capsaicin cough sensitivity, Patient Health Questionnaire-9 (PHQ-9), Major Depression Inventory (MDI), the Generalized Anxiety Disorder-7 scale (GAD-7), Life Events Scale (LES-32), induced sputum supernatant. The safety measures will be AEs/SAEs, vital signs, liver and kidney function, fecal occult blood test.DiscussionThis study is the first randomized, double-blind, and controlled clinical trial investigating the use of duloxetine in the treatment of refractory coughs. The study aims to provide a high-quality basis for evaluating the efficacy and safety of duloxetine for this condition.Trial registrationOur study was registered in the Chinese Clinical Trials Register (www.chictr.org.cn/) (ChiCTR2000037429) in 28/08/2020.

The effect of duloxetine on female sexual functions in the treatment of stress incontinence.

Stress urinary incontinence (SUI) is defined as urinary incontinence that occurs with coughing, sneezing, and physical exercise. It is frequently observed in women after middle age and has a negative impact on their sexual function. Duloxetine as one of the Serotonin-noradrenaline reuptake inhibitors (SNRIs) is commonly used in the non-surgical treatment of SUI. The aim of our study is to investigate the effect of duloxetine, which is used in the treatment of SUI, on sexual functions in female patients. The study included 40 sexually active patients who received duloxetine 40mg twice a day for the treatment of SUI. All patients had female sexual function index (FSFI), Beck's depression inventory (BDI), and incontinence quality of life score (I-QOL) applied before and 2months after starting duloxetine treatment. FSFI total score significantly increased from 19.9 to 25.7 (p < 0.001). In addition, significant improvement was observed in all sub-parameters of FSFI, including arousal, lubrication, orgasm, satisfaction, and pain/discomfort (p < 0.001, for each FSFI subtotal score). BDI significantly decreased from 4.5 to 1.5 (p < 0.001). I-QOL score significantly increased from 57.6 to 92.7 after the duloxetine treatment. Although SNRIs carry a high risk of sexual dysfunction, duloxetine may have an indirect positive effect on female sexual activity, both through its stress incontinence treatment and its antidepressant effect. In our study, Duloxetine, one of the treatment options for stress urinary incontinence and an SNRI, has a positive effect on stress urinary incontinence, mental health, and sexual activity in patients with SUI.

Duloxetine prevents bortezomib and paclitaxel large-fiber chemotherapy-induced peripheral neuropathy (LF-CIPN) in sprague dawley rats.

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating, treatment-limiting, side-effect of several classes of chemotherapy drugs. While negatively impacting oncology patients' quality of life, chemotherapy-induced large-fiber (LF) neuropathy is amongst the least well understood components of CIPN, and one for which there is currently no established therapy. Preliminary clinical observations have led to the suggestion that Duloxetine, which is used for the treatment of pain associated with small-fiber CIPN (SF-CIPN), may be effective against LF-CIPN. In the present experiments we developed a model of LF-CIPN and studied the effect of Duloxetine on LF-CIPN induced by two neurotoxic chemotherapy agents: the proteasome inhibitor, Bortezomib, a first-line treatment of multiple myeloma; and, the anti-microtubule taxane, Paclitaxel, used in the treatment of solid tumors. Since there are currently no models for selective the study of LF-CIPN, our first aim was to establish a pre-clinical model in the rat. LF-CIPN was evaluated with the Current Perception Threshold (CPT) assay, which uses a high frequency (1000Hz) electrical stimulus protocol that selectively activates large-fiber myelinated afferents. Our second aim was to use this model to test the hypothesis that Duloxetine can prevent LF-CIPN. We report that Bortezomib and Paclitaxel induce elevation of CPT, compatible with loss of large-fiber function, which are prevented by Duloxetine. Our findings support the clinical observation that Duloxetine may be an effective treatment for the large-fiber CIPN. We also suggest that CPT could be used as a biomarker for LF-CIPN in patients receiving neurotoxic chemotherapy.

Effect of duloxetine on pain and opioid consumption after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Although duloxetine has shown a positive effect on pain relief with hip and knee osteoarthritis, there is no pooled analysis of duloxetine for pain relief and opioid consumption in patients after total hip or knee arthroplasty. This systematic review and meta-analysis aimed to analyze pain control, opioid consumption, and associated adverse events of perioperative administration of duloxetine after total hip or knee arthroplasty. After being registered with PROSPERO (CRD42022323202), the databases of MEDLINE, PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from inception until March 20, 2023, for randomized controlled trials (RCTs). Primary outcomes were the visual Analog Scale (VAS) pain scores at rest (rVAS) and upon ambulation (aVAS). Secondary outcomes were postoperative opioid consumption quantified as oral morphine milligram equivalents (MMEs) and adverse effects of duloxetine. Nine RCTs with 806 cases were included. Duloxetine was associated with lower VAS scores at different times after surgery (24h, two weeks, and ≥ 3months). Compared to placebo, perioperative daily duloxetine use significantly reduced daily opioid MMEs at 24h (standard mean deviation [SMD] -0.71, 95% confidence interval [95% CI] -1.19 to -0.24,P = 0.003), three days (SMD -1.10, 95% CI -1.70 to -0.50,P = 0.0003), and one week (SMD -1.18, 95% CI -1.99 to -0.38,P = 0.004) after surgery. The duloxetine group had a significantly lower rate of nausea (odds ratio 0.62, 95% CI [0.41 to 0.94], P = 0.02) and a higher rate of drowsiness and somnolence (odds ratio 1.87, 95% CI [1.13 to 3.07], P = 0.01) compared to the placebo group. No significant differences were observed in the rates of other adverse events. Perioperative duloxetine significantly decreased postoperative pain and opioid consumption with good safety profiles. Further high quality designed and well-controlled randomized trials are warranted.

Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta-analysis of randomized clinical trials.

Duloxetine has been used as an adjunct in multimodal analgesia for acute postoperative pain in clinical studies. This meta-analysis aims to conclude whether oral duloxetine, when given perioperatively, is any better than a placebo in managing postoperative pain. Effects of duloxetine on postoperative pain scores, time to first rescue analgesia, postoperative rescue analgesia consumption, side effects attributable to duloxetine, and patient satisfaction profile were assessed. MEDLINE, Web of Science, EMBASE, Scholar Google, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched with keywords including "Duloxetine" AND "postoperative pain", "Duloxetine" AND "acute pain" and with "Duloxetine" till October 2022. This meta-analysis included randomized clinical trials in which perioperative duloxetine 60 mg per oral was administered not more than 7 days before surgery and for at least 24 after surgery but not more than 14 days after surgery. All RCTs in which the comparator is placebo and outcomes related to analgesic efficacy like pain scores, opioid consumption, and side effects of duloxetine until 48 h postoperatively were included. Data were extracted from the studies and a risk of bias summary was formed using the Cochrane Collaboration tool. Effect sizes were given as standardized mean differences for continuous outcomes and risk ratios (RR) by the Mantel-Haenszel test for the categorical outcome. Confirmation of publication bias was done by Egger's regression test (p < 0.05). If publication bias or heterogeneity was detected, the trim-and-fill method was used to calculate the adjusted effect size. Sensitivity analysis was done by leaving one out method after excluding the study with a high risk of bias. Subgroup analysis was done based on the type of surgery and gender. The study was prospectively registered in the PROSPERO under the registration number CRD42019139559. 29 studies with 2043 patients met the inclusion criteria and were reviewed for this meta-analysis. Postoperative pain scores at 24 h [Std. Mean Difference (95% CI); -0.69 (-1.07, -0.32)] and at 48 h [-1.13 (-1.68, -0.58)] are significantly less with duloxetine (p-value < 0.05). Time to first rescue analgesia was significantly more in patients where duloxetine was administered [1.27 (1.10, 1.45); p-value > 0.05]. Opioid consumption up to 24 h [-1.82 (-2.46, -1.18)] and 48 h [-2.48 (-3.46, -1.50)] was significantly less (p-value < 0.05) in patients who received duloxetine. Complications and recovery profiles were similar in patients receiving either duloxetine or a placebo. Based on GRADE findings, we conclude that there is low to moderate evidence to advocate the use of duloxetine for managing postoperative pain. Further trials are needed to replicate or refute these results based on robust methodology.

Effect of Duloxetine on opioid consumption and pain after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials.

The purpose of this study was to investigate the analgesic effects of duloxetine, specifically on postoperative pain, opioid consumption, and related side effects following total hip or knee arthroplasty. In this systematic review and meta-analysis, Medline, Cochrane, EMBASE, Scopus, and Web of Science were searched until November 2022 for studies which compared duloxetine with placebo when added to routine pain management protocols. Individual study risk of bias assessment was conducted based on Cochrane risk of bias tool 2. Random effect model meta-analysis was done on mean differences, to evaluate the outcomes. Nine randomized clinical trials (RCT) were included in the final analysis, totaling 806 patients. Duloxetine reduced opioid consumption (oral morphine milligram equivalents) on postoperative days (POD) two (mean difference (MD): - 14.35, p = 0.02), POD three (MD: -13.6, p < 0.001), POD seven (MD: -7.81, p < 0.001), and POD 14 (MD: -12.72, p < 0.001). Duloxetine decreased pain with activity on POD one, three, seven, 14, 90 (All p < 0.05), and pain at rest on POD two, three, seven, 14, and 90 (All p < 0.05). There was no significant difference in the prevalence of the side effects, except for increased risk of somnolence/drowsiness (risk ratio: 1.87, p = 0.007). Current evidence shows low to moderate opioid sparing effects of perioperative duloxetine and a statistically but not clinically significant reduction in pain scores. Patients treated with duloxetine had an increased risk for somnolence and drowsiness.

Duloxetine and Amitriptyline Reduce Neuropathic Pain by Inhibiting Primary Sensory Input to Spinal Dorsal Horn Neurons via α1- and α2-Adrenergic Receptors.

Antidepressants, such as duloxetine and amitriptyline, are effective for treating patients with chronic neuropathic pain. Inhibiting norepinephrine and serotonin transporters at presynaptic terminals raises extracellular concentrations of norepinephrine. The α1- and α2-adrenergic receptor agonists inhibit glutamatergic input from primary afferent nerves to the spinal dorsal horn. However, the contribution of spinal α1- and α2-adrenergic receptors to the analgesic effect of antidepressants and associated synaptic plasticity remains uncertain. In this study, we showed that systemic administration of duloxetine or amitriptyline acutely reduced tactile allodynia and mechanical and thermal hyperalgesia caused by spinal nerve ligation in rats. In contrast, duloxetine or amitriptyline had no effect on nociception in sham rats. Blocking α1-adrenergic receptors with WB-4101 or α2-adrenergic receptors with yohimbine at the spinal level diminished the analgesic effect of systemically administered duloxetine and amitriptyline. Furthermore, intrathecal injection of duloxetine or amitriptyline similarly attenuated pain hypersensitivity in nerve-injured rats; the analgesic effect was abolished by intrathecal pretreatment with both WB-4101 and yohimbine. In addition, whole-cell patch-clamp recordings in spinal cord slices showed that duloxetine or amitriptyline rapidly inhibited dorsal root-evoked excitatory postsynaptic currents in dorsal horn neurons in nerve-injured rats but had no such effect in sham rats. The inhibitory effect of duloxetine and amitriptyline was abolished by the WB-4101 and yohimbine combination. Therefore, antidepressants attenuate neuropathic pain predominantly by inhibiting primary afferent input to the spinal cord via activating both α1- and α2-adrenergic receptors. This information helps the design of new strategies to improve the treatment of neuropathic pain.

Retraction Note: Clinical effect of duloxetine on improving osteoporosis low back pain in older adults

Retraction Note: Clinical effect of duloxetine on improving osteoporosis low back pain in older adults

Effect of duloxetine on pain relief after total knee arthroplasty: A meta-analysis of randomized controlled trials.

Postoperative pain is one of the most feared complications of total knee arthroplasty. Recently, randomized controlled trials have compared the efficacy of duloxetine in patients undergoing total knee arthroplasty. However, there is no definite answer as to the efficacy and safety of duloxetine. Randomized controlled trials about relevant studies were searched from PubMed (1996 to July 2022), Embase (1996 to July 2022), and Cochrane Library (CENTRAL, July 2022). Six high-quality studies containing 532 patients met the inclusion criteria. Results show patients in the duloxetine group had better performance in terms of visual analog scale (P < .05), equivalent morphine consumption (P < .05), and length of stay (P < .05). Duloxetine can be used to reduce pain after knee arthroplasty in selected patients.

Effect of duloxetine as antidepressant on TM4 Sertoli cells: Evaluation of Bax and Cx43 gene expression

هدف: از چالش­های عمده بشریت افزایش افسردگی و اختلال عملکرد جنسی ناشی از داروهای ضدافسردگی است. با توجه به نقش سلول­های سرتولی در اسپرماتوژنز، پژوهش حاضر، اثر داروی دولوکستین را بر زنده­مانی، آپوپتوزیس و بیان ژن­های Bax و­ (Connexin 43) Cx43 در سلول­های سرتولی بررسی کرده است. مواد و روش‌‌ها: سلول­های TM4 در محیط DMEM/F12 حاوی %5/2 FBS، 5% سرم اسب و %1 پنی سیلین-استرپتومایسین کشت شدند. دولوکستین با دوزهای 30،60، 15، 5/7، 75/3 میکرو­گرم/ میلی­لیتر در زمان­های 24 تا 72 ساعت روی سلول­ها اثر داده شد. آزمون MTT جهت ارزیابی زنده­مانی سلول­ها، فلوسایتومتری جهت ارزیابی آپوپتوزیس و RT-qPCR جهت بررسی بیان ژن Bax (عامل پیش­برندۀ آپوپتوزیس) و Cx43 (ضروری برای اسپرماتوژنز) انجام شد. نتایج: دولوکستین در یک الگوی وابسته به دوز و زمان، بقای سلولی را کاهش داد. بر اساس داده­های MTT دوز IC50 15 میکروگرم/ میلی­لیتر در 48 ساعت محاسبه گردید (p≤0.05). آپوپتوزیس سلول­های TM4 نسبت به گروه کنترل در دوز میانه مهاری 15 میکروگرم/ میلی­لیتر دولوکستین، افزایش یافت (p≤0.01). RT-qPCR حاکی از افزایش بیان ژن­های Cx43 (p≤0.05) و Bax (p≤0.01) تحت تاثیر دولوکستین بود. نتیجه­گیری: با توجه به داده­های فلوسایتومتری و افزایش بیان ژن Bax، دولوکستین با القای آپوپتوزیس در سلول­های سرتولی می­تواند عاملی منفی و مخرب در پیشبرد اسپرماتوژنز در نظر گرفته شود. از سوی دیگر، دولوکستین با افزایش سطح بیان ژن Cx43، نقل و انتقالات مولکولی توسط اتصالات شکافدار را بین سلول­های سرتولی افزایش داده و می‫تواند باعث انتقال سیگنال­های پیش برنده آپوپتوزیس به سلول­های دودومان اسپرماتوژنیک و در نتیجه کاهش کیفیت اسپرماتوژنز ­شود.

Comparative Study between the Protective Role of Rosmarinic Acid and The Effect of Mesenchimal Stem Cells on Ameliorating the Toxic Effect of Duloxetine on the Parotid Gland of Male Albino Rats.

Comparative Study between the Protective Role of Rosmarinic Acid and The Effect of Mesenchimal Stem Cells on Ameliorating the Toxic Effect of Duloxetine on the Parotid Gland of Male Albino Rats.

Efficacy and Safety of Duloxetine in the Treatment of Fibromyalgia: A Systematic Review

Background: Fibromyalgia (FM) is a pain syndrome with manifestations of chronic musculoskeletal pain of non-articular were spread widely without being discovered abnormalities in the musculoskeletal system. In addition to widespread pain, patients with FM often experience other troublesome symptoms, such as fatigue, sleep disorders, and cognitive disorders; other specific pain conditions such as chronic headache. Frequently used therapies for treating FM are duloxetine, milnacipran, and pregabalin. Duloxetine is an antidepressant drug that belongs to the SNRI (serotonin norepinephrine reuptake inhibitors) class of drugs. The analgesic effect of duloxetine is believed to be the result of increased serotonin (5-HT) and noradrenaline (NA) activity in the central nervous system (CNS), by increasing the inhibition of pain pathways in the CNS and spinal cord. Methods: We conducted a system-based, computer-based literature search on 8 January 2020. We looked for literature relating to the effectiveness of duloxetine on pain management on FM, using keywords, fibromyalgia, pain, painful, management, therapy, treatment, duloxetine and SNRI. Results: Of the 5 papers that can be used in this review article, the sample population was 732 with FM and was treated with duloxetine. All studies show duloxetine can reduce pain scores and have a side effect that is mostly nausea and headache. Conclusion: Duloxetine can be used to reduce the pain suffered by FM patients and should also be prepared for other treatments to deal with the effects of arising. Keywords: Pain, Fibromyalgia, Duloxetine, effects.

Identification of Spinal Inhibitory Interneurons Required for Attenuating Effect of Duloxetine on Neuropathic Allodynia-like Signs in Rats.

Neuropathic pain is a chronic pain condition that occurs after nerve damage; allodynia, which refers to pain caused by generally innocuous stimuli, is a hallmark symptom. Although allodynia is often resistant to analgesics, the antidepressant duloxetine has been used as an effective therapeutic option. Duloxetine increases spinal noradrenaline (NA) levels by inhibiting its transporter at NAergic terminals in the spinal dorsal horn (SDH), which has been proposed to contribute to its pain-relieving effect. However, the mechanism through which duloxetine suppresses neuropathic allodynia remains unclear. Here, we identified an SDH inhibitory interneuron subset (captured by adeno-associated viral (AAV) vectors incorporating a rat neuropeptide Y promoter; AAV-NpyP+ neurons) that is mostly depolarized by NA. Furthermore, this excitatory effect was suppressed by pharmacological blockade or genetic knockdown of α1B-adrenoceptors (ARs) in AAV-NpyP+ SDH neurons. We found that duloxetine suppressed Aβ fiber-mediated allodynia-like behavioral responses after nerve injury and that this effect was not observed in AAV-NpyP+ SDH neuron-selective α1B-AR-knockdown. These results indicate that α1B-AR and AAV-NpyP+ neurons are critical targets for spinal NA and are necessary for the therapeutic effect of duloxetine on neuropathic pain, which can support the development of novel analgesics.

Efficacy of postoperative analgesia with duloxetine in posthemorrhoidectomy pain: a prospective, randomized, double-blind and placebo-controlled trial

BackgroundTo evaluate the effect of duloxetine when added to a multimodal analgesia regimen on posthemorrhoidectomy pain, opioid consumption, and side effects.MethodsProspective, randomized, double-blind placebo-controlled trial. This study included 62 patients who underwent hemorrhoidectomy. The patients were randomly assigned to receive oral duloxetine 60 mg or placebo 2 h before and 24 h after surgery. The primary outcomes were pain intensity - measured on an 11-point visual analog pain scale - and cumulative morphine consumption at 12, 24, and 48 postoperative hours.ResultsFifty-two patients completed the study (25 in the duloxetine group and 27 in the placebo group). Pain scores did not differ between duloxetine and placebo: 4.5; 3.0 – 7.0 vs. 5.0; 3.5 – 7.0, p = 0.68 at 12 h, 3.0; 2.0 – 5.0 vs. 3.0; 2.0 – 5.0, p = 0.56 at 24 h, and 2.5; 1.75 – 3.75 vs. 1.5; 0.5 – 3, p = 0.08 at 48 h. Further, cumulative morphine consumption did not differ between the duloxetine and placebo groups: 4; 1.25 – 10.75 mg vs. 7; 1.0 – 12.0 mg, p = 0.68 at 12 h, 9.5; 2.0 – 17.5 mg vs. 8.0; 4.0 – 18.0 mg; p = 0.80 at 24 h, and 11.0; 2.0 – 27.0 mg vs. 10; 4.0 – 24.0 mg, p = 0.78 at 48 h. Side effects did not differ between the groups.ConclusionsCompared with placebo, duloxetine did not decrease pain intensity or morphine consumption during the first 48 h postoperatively.Trial registrationThe study was retrospectively registered on the Brazilian Clinical Trials Registry (identifier: RBR-9pdgms, registration date: 08/10/2020).

The anterior cingulate cortex contributes to the analgesic rather than the anxiolytic effects of duloxetine in chronic pain-induced anxiety.

Mood disorders, such as anxiety and depression, are commonly found in people suffering from chronic pain. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are potential in alleviating chronic pain and are the first-line option for anxiety disorder. The anterior cingulate cortex (ACC) plays a vital role in chronic pain-induced anxiety, but its role in the therapeutic effects of SNRIs remains largely unclear. We used complete Freund's adjuvant (CFA) in this current study to induce chronic inflammatory pain. Von Frey test was used to measure the mechanical withdrawal threshold. The elevated plus maze test (EPM) and the novelty-suppressed feeding test (NSF) were used to measure anxiety-like behaviors. Twenty-one days after the modeling, anxiety-like behaviors were successfully induced in CFA mice, and a 3-day intraperitoneal injection of duloxetine attenuated such behaviors. While, mechanical hyperalgesia was also improved. Then, we locally infused duloxetine in ACC for 3 days only to find out its analgesic effect in CFA mice. Furthermore, we used fiber photometry to discover decreased glutamatergic excitability and enhanced serotonin concentration in ACC after intraperitoneal injection of duloxetine. Overall, this study proposed a potential mechanism for the analgesic effect of duloxetine and shed light on further studies on the mechanism of its anxiolytic effect in chronic pain-induced anxiety.

Management of Diabetic Neuropathy: A Comparison of Duloxetine with Amitriptyline

Objective: To evaluate the pain-relieving effects of duloxetine vs those of amitriptyline in the treatment of diabetic neuropathy. Methodology: In this randomized trial control, 150 cases of diabetic neuropathy by using convenient sampling technique from Medical Department of Madinah Teaching Hospital, Faisalabad were enrolled and divided in 2 equal groups randomly. Group A was assigned to (Duloxetine) and B assigned to (Amitriptyline). Patients received the trial drug in the morning with water for 6 weeks. Group A got 60 mg of Duloxetine and Group B 75 mg of amitriptyline. VAS pain rating. Patient consultations included a diary card. Patients recorded daily improvements on a visual analogue scale for the first three weeks. We administered three weeks of medicine and arranged an examination in week 6. When pain levels were 50% lower than baseline, we rated them as reduced. Patients were phoned. Results: The mean age was 46.19+6.39 years. 41(54.67%) of Group-A and 39(52%) of Group-B were male, whereas 34(45.33%) and 36(48%) were female. Both groups' mean VAS pain ratings were 1.48+0.50; p = 0.746 shows no difference. Group-A (0.48+0.50) and Group-B (0.92+0.69) vary significantly (p=0.0001). Group-A (52%) and Group-B (28%) were effectively treated after 6 weeks, p=0.002. Conclusion: Our research shows that duloxetine is superior to amitriptyline for the management of diabetic neuropathy, especially in terms of minimising the frequency with which patients report experiencing pain. Keywords: Diabetic neuropathy, management, duloxetine, amitriptyline, efficacy

Significant Analgesic Benefits of Perioperative Duloxetine in Patients Who Have Depressive Symptoms Undergoing Total Hip Arthroplasty: A Randomized Controlled Trial

BackgroundMajor symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients. MethodsAmong 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded. ResultsThe duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups. ConclusionPerioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms.

Tolerability and efficacy of duloxetine for the prevention of persistent musculoskeletal pain after trauma and injury: a pilot three-group randomized controlled trial.

This study investigated the tolerability and preliminary efficacy of duloxetine as an alternative nonopioid therapeutic option for the prevention of persistent musculoskeletal pain (MSP) among adults presenting to the emergency department with acute MSP after trauma or injury. In this randomized, double-blind, placebo-controlled study, eligible participants (n = 78) were randomized to 2 weeks of a daily dose of one of the following: placebo (n = 27), 30 mg duloxetine (n = 24), or 60 mg duloxetine (n = 27). Tolerability, the primary outcome, was measured by dropout rate and adverse effects. Secondary outcomes assessed drug efficacy as measured by (1) the proportion of participants with moderate to severe pain (numerical rating scale ≥ 4) at 6 weeks (pain persistence); and (2) average pain by group over the six-week study period. We also explored treatment effects by type of trauma (motor vehicle collision [MVC] vs non-MVC). In both intervention groups, duloxetine was well tolerated and there were no serious adverse events. There was a statistically significant difference in pain over time for the 60 mg vs placebo group ( P = 0.03) but not for the 30 mg vs placebo group ( P = 0.51). In both types of analyses, the size of the effect of duloxetine was larger in MVC vs non-MVC injury. Consistent with the role of stress systems in the development of chronic pain after traumatic stress, our data indicate duloxetine may be a treatment option for reducing the transition from acute to persistent MSP. Larger randomized controlled trials are needed to confirm these promising results.

Outcomes and Predictors of Response of Duloxetine for the Treatment of Persistent Idiopathic Dentoalveolar Pain: A Retrospective Multicenter Observational Study.

BackgroundDuloxetine has been reported to significantly relieve the pain of persistent idiopathic dentoalveolar pain (PIDP); however, the number of studies available is scarce and no study has identified the predictors of response of duloxetine for the treatment of PIDP.ObjectiveTo report the efficacy, safety, and identification of positive predictors of duloxetine for PIDP patients through a retrospective multicenter observational study.MethodsWe retrospectively reviewed the clinical database of PIDP patients who were prescribed duloxetine at 3 hospitals between January 2018 and November 2021. Demographic and pain-related baseline data, efficacy of patients after 3 months of medication by visual analog scale (VAS) scores for pain and adverse events were extracted and analyzed. The predictors of pain-relieving effect of duloxetine were identified by logistic regression analysis.ResultsA total of 135 patients were included in this study. Side effects occurred immediately after taking duloxetine in 24 (17.8%) patients, and the treatment with duloxetine was discontinued on 13 of them because they could not tolerate the side effects. Other 11 (8.1%) patients gradually tolerated the side effects within 2 weeks. Ninety-four out of 122 (77.0%) patients obtained pain relief with VAS significantly decreased (p < 0.01) and the other 28 (23.0%) patients stopped taking the drug because of weak efficacy. Binary logistic regression analysis showed that short disease duration (OR = 1.017, 95% CI = 1.004–1.030, P = 0.012) was an independent predictor of the positive response of duloxetine.ConclusionThis study confirmed that duloxetine can significantly improve chronic pain of PIDP patients, and the safety was tolerable. Patients with shorter disease duration had more benefit from duloxetine.LimitationsThis is a retrospective observational study. Long-term efficacy and safety of duloxetine in the treatment of PIDP patients were not evaluated.