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Saturday, 25 February 2012

Antidepressants help Osteoarthritis patients like FIDDAMAN - The Evidence is Clear ...

Duloxetine Added to Oral Nonsteroidal Anti-inflammatory Drugs for Treatment of Knee Pain Due to Osteoarthritis: Results of a Randomized, Double-Blind, Placebo-Controlled Trial

Frakes EP, Risser RC, Ball TD, Hochberg MC, Wohlreich MM

Curr Med Res Opin. 2011;27:2361-2372

Study Summary

In a randomized, double-blind, flexible-dose study of duloxetine 60/120 mg/day that enrolled 524 adult outpatients (mean age, 61 years) who had persistent moderate pain due to osteoarthritis of the knee, despite optimized therapy with oral nonsteroidal anti-inflammatory drugs, duloxetine-treated patients had significantly greater pain reduction than placebo recipients. Moreover, at week 8, duloxetine-treated patients had significant improvements in physical function and Patient Global Impression of Improvement scores. Finally, significantly more duloxetine recipients than placebo recipients reported nausea, dry mouth, constipation, fatigue, and decreased appetite, and discontinuation due to adverse events occurred more commonly in the duloxetine group than the placebo group.


Antidepressant treatments have long been used to manage pain syndromes. Duloxetine is approved by the US Food and Drug Administration for chronic musculoskeletal pain, including osteoarthritis. The mechanism of action is thought to be related to the amelioration of central pain pathway dysfunction.

It is common for patients to receive a combination of medications for osteoarthritic pain. In this study, 40 of 264 patients (15.2%) receiving adjunctive duloxetine vs 23 of 260 patients (8.8%) receiving adjunctive placebo discontinued therapy because of an adverse event, for a number needed to harm of 16 (95% CI, 9-130). However, moderate improvement in pain (defined by ≥ 30% improvement in the diary-based measure of pain severity) was observed in 139 of 259 patients (53.7%) in the duloxetine group and 86 of 255 patients (33.7%) in the placebo group, for a number needed to treat of 6 (95% CI, 4-9). Although the study was short, it provides a signal that adjunctive duloxetine (and perhaps other antidepressants with similar mechanisms of action on serotonin and norepinephrine receptors) may be useful to consider when treating osteoarthritic pain.


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