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

Abstract

Background: Duloxetine 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. Objective: To report the efficacy, safety, and identification of positive predictors of duloxetine for PIDP patients through a retrospective multicenter observational study. Methods: We 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. Results: A 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. Conclusion:This 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. Limitations: This is a retrospective observational study. Long-term efficacy and safety of duloxetine in the treatment of PIDP patients were not evaluated.

Treatment of Persistent Idiopathic Dentoalveolar Pain with Venlafaxine: A Multicentric Retrospective Study on Its Effectiveness and Safety

“…The lack of specificity in its clinical manifestations makes timely and accurate diagnosis challenging. 1 , 7 PIDP may occur spontaneously or after dental procedures. Clinical somatosensory assessment can either show positive or negative signs.…”

“…Currently, there is a lack of high-quality clinical trials to establish standardized treatment modalities for PIDP, and treatment approaches are based on expert recommendations and clinical experiences. 7 , 14 Tricyclic antidepressants (TCAs) and antiepileptics have been used to treat PIDP, with TCAs often being the first line of treatment, although their effectiveness is limited. 15 , 16 Local anesthetics and Onabotulinumtoxin A injections are alternative options, but the evidences are from studies with smaller sample sizes and are rather inconsistent.…”

“… 19 , 20 Jia et al reported that duloxetine, as a SNRIs, can significantly improve chronic pain of PIDP patients, with tolerable side effects, which added to the evidence for the potential of SNRIs. 7 However, some patients do not respond well to duloxetine or experienced intolerable side effects; therefore, the effects of other SNRIs should also be studied.…”

Особливості Фармакологічної Корекції Соматичних Проявів Депресії Та Когнітивного Зниження У Хворих Із Тривожно-Депресивними Розладами У Воєнний Час

“…Його застосування сприяло вірогідному зменшенню вираженості атипової одонталгії у 77% хворих, при цьому найвищу ефективність дулоксетину констатували при мінімальній тривалості захворювання (відношення шансів (ВШ) 1,017; 95% ДІ 1,004-1,030; р=0,012) (рис. 2)[26]. Зазначимо, що в цьому дослідженні дозу дулоксетину обережно титрували з 20 мг 1 раз на добу до 40; 60; 80; 100 або 120 мг/добу залежно від переносимості та появи побічних реакцій.…”

“…Зазначимо, що в цьому дослідженні дозу дулоксетину обережно титрували з 20 мг 1 раз на добу до 40; 60; 80; 100 або 120 мг/добу залежно від переносимості та появи побічних реакцій. Динаміка показників візуальної аналогової шкали при атиповій одонталгії на тлі лікування дулоксетином[26]…”