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Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia

  1. Michael PT Lunn1,*,
  2. Richard AC Hughes2,
  3. Philip J Wiffen3

Editorial Group: Cochrane Neuromuscular Group

Published Online: 3 JAN 2014

Assessed as up-to-date: 19 NOV 2013

DOI: 10.1002/14651858.CD007115.pub3


How to Cite

Lunn MPT, Hughes RAC, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD007115. DOI: 10.1002/14651858.CD007115.pub3.

Author Information

  1. 1

    National Hospital for Neurology and Neurosurgery, Department of Neurology and MRC Centre for Neuromuscular Diseases, London, UK

  2. 2

    National Hospital for Neurology and Neurosurgery, MRC Centre for Neuromuscular Diseases, London, UK

  3. 3

    University of Oxford, Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics), Oxford, Oxfordshire, UK

*Michael PT Lunn, Department of Neurology and MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. michael.lunn@uclh.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 3 JAN 2014

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[Figure 1]
Figure 1. Methodological quality summary: review authors' judgements about each methodological quality item for each included study. Green = low risk of bias; yellow = unclear risk of bias; red = high risk of bias
[Figure 2]
Figure 2. Duloxetine versus placebo in the treatment of painful neuropathy: Number of patients with >50% improvement of pain at <12 weeks.
[Figure 3]
Figure 3. Duloxetine versus placebo in the treatment of pain: Mean improvement in pain at 12 weeks.
[Figure 4]
Figure 4. Duloxetine versus placebo in the treatment of pain: Number of patients with >30% improvement in pain at <12 weeks.
[Figure 5]
Figure 5. Duloxetine versus placebo in the treatment of pain: Patient reported global impression of change.
[Figure 6]
Figure 6. Duloxetine versus placebo in the treatment of pain: BPI severity - average pain.
[Figure 7]
Figure 7. Trial sequential analysis of duloxetine versus placebo in the treatment of painful neuropathy - 50% or more reduction in pain at 8-12 weeks with at least 8 weeks of treatment
[Figure 8]
Figure 8. Duloxetine versus placebo in the treatment of fibromyalgia: >30% improvement <12 weeks.
[Figure 9]
Figure 9. Duloxetine versus placebo in the treatment of fibromyalgia: SF-36 bodily pain.
[Figure 10]
Figure 10. Trial sequential analysis of duloxetine 60 mg versus placebo for the 50% reduction in pain in fibromyalgia with at least 8 weeks treatment at 8-12 weeks
[Figure 11]
Figure 11. Trial Sequential Analysis of duloxetine 60 mg versus placebo in the treatment of painful physical symptoms in depression at less than 12 weeks with at least eight weeks of treatment
[Figure 12]
Figure 12. Adverse events leading to cessation of treatment.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 1 Number of participants with ≥ 50% improvement of pain at 12 weeks or less.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 2 Mean improvement in pain at 12 weeks or less.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 3 Number of participants with ≥ 30% improvement in pain at 12 weeks or less.
[Analysis 1.4]
Analysis 1.4. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 4 Mean improvement in SF-36 Physical Subscore at 12 weeks or less.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 5 Mean improvement in SF-36 Mental Subscore at 12 weeks or less.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 6 Mean improvement in SF-36 Bodily Pain Subscore at 12 weeks or less.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 7 Mean improvement in Patient Reported Global Impression of Improvement at 12 weeks or less.
[Analysis 1.8]
Analysis 1.8. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 8 Mean improvement in BPI Severity - average pain at 12 weeks or less.
[Analysis 1.9]
Analysis 1.9. Comparison 1 Duloxetine versus placebo in the treatment of painful diabetic neuropathy, Outcome 9 Mean improvement in pain at rest (night pain) at 12 weeks or less.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Duloxetine versus pregabalin in the treatment of painful diabetic neuropathy, Outcome 1 Number of participants with ≥ 50% improvement in pain at 12 weeks or less.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Duloxetine versus pregabalin in the treatment of painful diabetic neuropathy, Outcome 2 Mean improvement in pain at 12 weeks or less.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Duloxetine versus pregabalin in the treatment of painful diabetic neuropathy, Outcome 3 Number improved ≥ 30% at 12 weeks or less.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 1 Number of participants with ≥ 50% improvement of pain at 12 weeks or less.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 2 Number of participants with ≥ 50% improvement of pain at more than 12 weeks.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 3 Number of participants with ≥ 30% improvement of pain at 12 weeks or less.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 4 Mean improvement in pain at 12 weeks or less.
[Analysis 3.5]
Analysis 3.5. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 5 Mean improvement in the SF-36 mental component summary subscore.
[Analysis 3.6]
Analysis 3.6. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 6 Mean improvement in the SF-36 physical component summary subscore.
[Analysis 3.7]
Analysis 3.7. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 7 Mean improvement in the SF-36 Bodily Pain Subscore.
[Analysis 3.8]
Analysis 3.8. Comparison 3 Duloxetine versus placebo in the treatment of fibromyalgia, Outcome 8 Mean improvement in the Patient reported Global Impression of Change at completion of trial.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Duloxetine versus placebo for the treatment of pain in major depressive disorder, Outcome 1 Number of participants with > 50% pain relief at 12 weeks or less.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Duloxetine versus placebo for the treatment of pain in major depressive disorder, Outcome 2 Participants with > 30% pain relief at 12 weeks or less.
[Analysis 4.3]
Analysis 4.3. Comparison 4 Duloxetine versus placebo for the treatment of pain in major depressive disorder, Outcome 3 Mean improvement in pain at 12 weeks or less.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Duloxetine versus placebo in the treatment of central neuropathic pain, Outcome 1 Mean improvement in pain at 12 weeks or less.
[Analysis 5.2]
Analysis 5.2. Comparison 5 Duloxetine versus placebo in the treatment of central neuropathic pain, Outcome 2 Mean improvement in SF-36 Physical Subscore.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Duloxetine versus placebo in the treatment of central neuropathic pain, Outcome 3 Mean improvement in the SF-36 Mental Subscore at 12 weeks.
[Analysis 5.4]
Analysis 5.4. Comparison 5 Duloxetine versus placebo in the treatment of central neuropathic pain, Outcome 4 Mean improvement in the SF-36 Bodily Pain Subscore.
[Analysis 5.5]
Analysis 5.5. Comparison 5 Duloxetine versus placebo in the treatment of central neuropathic pain, Outcome 5 Number of participants improved on PGI-I (better or very much better).
[Analysis 6.1]
Analysis 6.1. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 1 Proportion of participants with any adverse event.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 2 Nausea.
[Analysis 6.3]
Analysis 6.3. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 3 Dry mouth.
[Analysis 6.4]
Analysis 6.4. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 4 Dizziness.
[Analysis 6.5]
Analysis 6.5. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 5 Somnolence.
[Analysis 6.6]
Analysis 6.6. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 6 Adverse event leading to cessation.
[Analysis 6.7]
Analysis 6.7. Comparison 6 Duloxetine versus placebo: adverse events during first 12 weeks of treatment for painful neuropathy or fibromyalgia, Outcome 7 Serious adverse event.