Duloxetine

Bellingham, Geoff A.; Peng, Philip

doi:10.1097/aap.0b013e3181df2645

Cited by 58 publications

(16 citation statements)

References 72 publications

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“…Central sensitization is dependent upon the activation of a descending pain facilitatory pathway originating in the brainstem [52]. Duloxetine, by enhancing monoaminergic tone, may potentially reduce the consequences of central sensitization by shifting the descending pain modulatory pathway from a state of facilitation to a state of inhibition [16, 17]. Consistent with the preclinical data, duloxetine, has demonstrated remarkable consistency of analgesic effect across all 3 main categories of chronic pain.…”

Section: Discussionmentioning

confidence: 90%

“…In chronic pain states, the net inhibitory effect of these monoamines is postulated to be reduced or lost; consequently, shifting the descending pain modulatory system from a state of inhibition towards a state of pain facilitation [16, 17]. Duloxetine is a potent and selective inhibitor of 5-HT and NE reuptake in vitro and in vivo in the central nervous system (CNS) [18].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Duloxetine in Patients with Chronic Pain Conditions

Skljarevski¹,

Zhang²,

Iyengar³

et al. 2011

CDTH

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The primary objective of this study is to review the efficacy of duloxetine in treating chronic pain using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations for clinical significance across chronic pain states. These include pain intensity, patient ratings of overall improvement, physical functioning, and mental functioning. This review comprised the side-by-side analyses of 12 double-blind, placebo-controlled trials of duloxetine in patients with chronic pain (diabetic peripheral neuropathic pain, fibromyalgia, chronic pain due to osteoarthritis, and chronic low back pain). Patients received duloxetine (60 to 120 mg/day) or placebo. Average pain reduction was assessed over 3 months as the primary efficacy outcome. Other measures used were physical function and Patient Global Impression of Improvement. In 10 of the 12 studies, statistically significant greater pain reduction was observed for duloxetine- compared with placebo-treated patients. The response rates based on average pain reduction, improvement of physical function, and global impression were comparable across all 4 chronic pain states. Compared with patients on placebo, significantly more patients treated with duloxetine reported a moderately important pain reduction (≥30% reduction) in 9 of the 12 studies, a minimally important improvement in physical function in 8 of the 12 studies, and a moderately important to substantial improvement in Patient Global Impression of Improvement rating in 11 of the 12 studies. The analyses reported here show that duloxetine is efficacious in treating chronic pain as demonstrated by significant improvement in pain intensity, physical functioning, and patient ratings of overall improvement.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Efficacy of Duloxetine in Patients with Chronic Pain Conditions

Skljarevski¹,

Zhang²,

Iyengar³

et al. 2011

CDTH

View full text Add to dashboard Cite

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“…For instance, serotonin-norepinephrine reuptake inhibitors (SNRI) have been successfully used in the management of pain in chronic or recurrent LBP [60] and have shown to decrease disability [61]. SNRIs could act on restoring or improving pain inhibition [62, 63] and alleviating depressive symptoms [60], which are known to be linked to chronic back pain [64]. Even if pain inhibition processes only explained 9.4% of variance in future disability, the use of SNRIs could be considered in multidisciplinary approaches as SNRIs not only act on pain inhibition processes, but also help with depressive symptoms often observed in individuals with LBP [60].…”

Section: Discussionmentioning

confidence: 99%

Physiological and Psychological Predictors of Short-Term Disability in Workers with a History of Low Back Pain: A Longitudinal Study

et al. 2016

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Despite an elusive pathophysiology, common characteristics are often observed in individuals with chronic low back pain (LBP). These include psychological symptoms, altered pain perception, altered pain modulation and altered muscle activation. These factors have been explored as possible determinants of disability, either separately or in cross-sectional studies, but were never assessed in a single longitudinal study. Therefore, the objective was to determine the relative contribution of psychological and neurophysiological factors to future disability in individuals with past LBP. The study included two experimental sessions (baseline and six months later) to assess cutaneous heat pain and pain tolerance thresholds, pain inhibition, as well as trunk muscle activation. Both sessions included the completion of validated questionnaires to determine clinical pain, disability, pain catastrophizing, fear-avoidance beliefs and pain vigilance. One hundred workers with a history of LBP and 19 healthy individuals took part in the first experimental session. The second experimental session was exclusively conducted on workers with a history of LBP (77/100). Correlation analyses between initial measures and disability at six months were conducted, and measures significantly associated with disability were used in multiple regression analyses. A first regression analysis showed that psychological symptoms contributed unique variance to future disability (R2 = 0.093, p = .009). To control for the fluctuating nature of LBP, a hierarchical regression was conducted while controlling for clinical pain at six months (R2 = 0.213, p < .001) where pain inhibition contributed unique variance in the second step of the regression (R2 change = 0.094, p = .005). These results indicate that pain inhibition processes may constitute potential targets for treatment to alleviate future disability in individuals with past or present LBP. Then again, the link between psychological symptoms and pain inhibition needs to be clarified as both of these factors are linked together and influence disability in their own way.

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“…Both serotonin (5-HT) and norepinephrine (NE) are key modulators of endogenous pain inhibitory mechanisms via the descending pain inhibitory pathways in the brain and spinal cord 8. It has been postulated that in FM, the net inhibitory effect of critical monoamines, such as 5-HT and NE, is reduced or lost, consequently shifting the descending pain modulatory system from a state of inhibition toward a state of pain facilitation 9,10. This idea is supported by the clinical observation that FM patients have lower levels of 5-HT and NE metabolites in their cerebrospinal fluid compared to controls 11,12…”

Section: Introductionmentioning

confidence: 99%

Predictors of duloxetine adherence and persistence in patients with fibromyalgia

Cui¹,

Zhao²,

Novick³

et al. 2012

JPR

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ObjectivesAdherence to medication for the treatment of fibromyalgia (FM) is predictive of lower overall health-care costs, and thus a lower burden on both patients and providers. The objectives of this study were to examine the predictors of adherence to and persistence with duloxetine therapy among commercially insured FM patients, and to identify subgroups of patients with high duloxetine persistence and adherence.Study designThis cross-sectional, retrospective study analyzed medical and pharmacy records over 1 year for patients in the US aged 18–64 years with FM who initiated (no prior 90-day use) duloxetine treatment in 2008.MethodsAdherence to duloxetine was measured by medication possession ratio (MPR), with high adherence defined as MPR ≥ 0.8. Persistence was defined as the duration of therapy from the index date to the earliest of: the ending date of the last prescription, the date of the first gap of >15 days between prescriptions, or the end of the study period (12 months). Demographic and clinical predictors of adherence were examined via multiple logistic regression (MLR), and subgroups of duloxetine-persistent and -adherent patients were identified using classification and regression trees (CART).ResultsAmong 4660 duloxetine patients, 33% achieved high adherence. Factors associated with high adherence from MLR included older age, North Central and Northeast regions, prior venlafaxine, pregabalin, selective serotonin reuptake inhibitor (SSRI), or other antidepressant use, or comorbid dyslipidemia or osteoarthritis (all P < 0.05). CART analysis revealed that patients with prior antidepressant use, aged ≥46, or prior osteoarthritis had higher MPR (all P < 0.05), and patients aged ≥45 with a history of SSRI, venlafaxine, or anticonvulsant use had longer duration of therapy (all P < 0.05).ConclusionsPatients with high adherence to and persistence with duloxetine were significantly older and had prior antidepressant use.

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Duloxetine

Cited by 58 publications

References 72 publications

Efficacy of Duloxetine in Patients with Chronic Pain Conditions

Efficacy of Duloxetine in Patients with Chronic Pain Conditions

Physiological and Psychological Predictors of Short-Term Disability in Workers with a History of Low Back Pain: A Longitudinal Study

Predictors of duloxetine adherence and persistence in patients with fibromyalgia

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