Duloxetine improves depression-related pain

By Will Boggs, MD

NEW YORK (Reuters Health) - Treatment with duloxetine relieves pain in patients with major depressive disorder, according to a report in the Journal of Clinical Psychiatry.

Duloxetine is used to treat depression and generalized anxiety disorder. It is also used to treat pain and tingling caused by diabetic neuropathy.

The drug belongs to a class of medications called selective serotonin and norepinephrine reuptake inhibitors and works by increasing brain levels of serotonin and norepinephrine, natural substances that help maintain mental balance and block pain signals.

Painful physical symptoms in depression receive inadequate attention, note Dr. Stephan Brecht from Boehringer Ingelheim, Germany and colleagues. The investigators therefore evaluated the effectiveness of duloxetine compared with placebo for treating pain in 327 patients with moderate-to-severe pain associated with depression.

After 8 weeks of treatment, the pain improved significantly more in patients treated with duloxetine than in those who received placebo, the authors report. Patients receiving duloxetine also experienced greater improvements in the categories of "worst pain," "least pain," and "pain-right-now."

The effects of duloxetine treatment were significant as early as week 1, and duloxetine patients achieved sustained responses faster than did placebo patients.

The response rates for the reduction of average pain levels at week 8 were higher for duloxetine patients (60.3 percent) than for placebo patients (44.0 percent), the researchers note, and improvements in daily functioning were significantly better for duloxetine patients.

Depression severity was also significantly reduced by 8 weeks of treatment with duloxetine, compared with placebo, the investigators add.

Duloxetine patients reported more adverse events than did placebo patients, with nausea, excessive perspiration, and dry mouth being the most commonly reported treatment-related side effects.

The investigators conclude that these results support the effectiveness and tolerability of duloxetine in the treatment of both pain and depression in patients who have moderate-to-severe pain associated with depression.

SOURCE: Journal of Clinical Psychiatry, November 2007.