Clinical Use of Duloxetine for Chronic Pain Patients

Abstract

  Duloxetine (DLX) is an important drug for the treatment of neuropathic pain, especially painful diabetic neuropathy, and is classified as a first or second line therapy in some guidelines. In Japan, DLX is the only antidepressant approved to treat neuropathic pain at present. In the United States, DLX has also been approved by the FDA for the treatment of fibromyalgia and musculoskeletal pain such as osteoarthritis and chronic low back pain. Most adverse effects of DLX are mild to moderate in severity, and the drug is well tolerated by most patients. In addition, DLX appears to have minimal effects on body weight in the majority of patients, and is therefore acceptable for patients when effects on weight are considered in the selection of a medication. While some degree of pain relief would be expected to accompany improvement of mood for antidepressants, DLX evidently exerts a direct analgesic effect independent of its antidepressant effect. This drug is highly effective in reducing several types of pain while not producing the wide spectrum of side effects noted with other treatment regimens. We also describe here how we use DLX in our outpatient clinic.