Sunday, October 30, 2005

Yes, duloxetine is effective for painful diabetic neuropathy

The current Pain presents another randomized, placebo-controlled trial looking at duloxetine in painful diabetic neuropathy.  348 people were enrolled who were not depressed and on no analgesics (traditional or adjuvant) other than acetaminophen & were randomized to 60mg qday, bid, or placebo.  Both the 60mg qday & bid were more effective than placebo (starting at about 1 week and lasting for the 12 weeks of the trial).  The effect, typical for neuropathic pain trials with adjuvants, was quite modest, about -2.5 on the 11 point pain scale (placebo was about -1.2), but statistically significant.  Importantly, 60mg daily provided equivalent relief to 60mg bid but with markedly fewer side effects.  For those of you who haven't used duloxetine (Cymbalta), it's a relatively new antidepressant that is both a serotonin and norepinephrine reuptake inhibitor and so has more promise as an analgesic than the traditional SSRI's.  It actually has an indication for treating painful diabetic neuropathy already but it seems the editors of Pain thought the world needed one more article about this.  I suspect there will be more RCTs involving it in other neuropathic pain states.

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