Efficacy of duloxetine, a potent and selective 5-HT/NE reuptake inhibitor, in rat models of persistent and neuropathic pain

Iyengar, Smriti; Li, D.L.; Lee, D.H.; Simmons, Rosa Maria A.

doi:10.1016/s0924-977x(01)80187-5

Cited by 2 publications

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“…Antidepressants with 5-HT and NE effects fare better than those with either neurotransmitter influence alone. 20 While animal studies suggest duloxetine's antinociceptive effect, 26,27 it is not clear how this generalizes to chronic pain in humans. Given that duloxetine exerts simultaneous influences on both 5-HT and NE, it is expected that duloxetine may demonstrate promise with regard to the treatment of depression and depression associated with chronic pain and may even exert some analgesic effect.…”

Section: Discussionmentioning

confidence: 99%

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Antidepressant Use in Chronic Pain Management

Leo

Barkin²

2003

Prim. Care Companion CNS Disord.

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BACKGROUND: Duloxetine is a novel antidepressant that is anticipated to be clinically available soon. It exerts simultaneous noradrenergic and serotonergic neurotransmitter effects. Because of these influences, it is postulated to have a role in management of pain. DATA SOURCES: An Index Medicus search from 1997 to 2003 was conducted using the search terms duloxetine, Cymbalta, and pain. DATA ANALYSIS: Preclinical animal studies suggest that duloxetine may have a direct analgesic role. Premarketing studies have emphasized its utility in alleviating somatic, specifically pain, complaints among patients with major depression. CONCLUSION: Although promising, these results cannot be generalized to patients with pain disorders; the reasons for this are discussed herein. While duloxetine may be useful among somatizing depressed patients and possibly chronic pain patients with comorbid depression, its analgesic role has yet to be elucidated in future research.

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Section: Discussionmentioning

confidence: 99%

“…In tests to simulate persistent inflammation, the agent formalin is injected beneath the footpad of an animal. 27 The formalin induces pain for approximately 1 hour, divided into 2 phases. The first of these is a relatively brief phase, lasting up to approximately 15 minutes.…”

Section: Efficacy Of Duloxetine In Animal Models Of Chronic Painmentioning

confidence: 99%

Antidepressant Use in Chronic Pain Management

Leo

Barkin²

2003

Prim. Care Companion CNS Disord.

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“…Results from these analyses demonstrated that improvement in pain severity was associated with an increased probability of achieving remission even after accounting for improvement in core emotional symptoms of depression. 5 These data are clearly inconsistent with Leo and Barkin's assertion that duloxetine may simply produce "a reduction in somatic preoccupation accompanying relief of an underlying depression." 1(p121) In their discussion, the authors state that "on the basis of the available data, it is impossible to separate out any analgesic effects of duloxetine from its antidepressant effects."…”

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confidence: 90%

“…Preliminary animal studies, 5 as well as a recent examination of pain-mitigating effects among patients with diabetic neuropathy 6 (published after the submission of the 2003 Leo and Barkin article), suggest that duloxetine may have a role in pain management. However, many antidepressants and anticonvulsants have likewise demonstrated efficacy in neuropathy.…”

Section: Dr Leo Repliesmentioning

confidence: 99%

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The Role of Duloxetine in the Treatment of Depression and Associated Painful Physical Symptoms

Wohlreich¹,

Watkin²

2003

Prim. Care Companion CNS Disord.

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Sir:The recent article by Leo and Barkin 1 raises a number of interesting questions concerning the role of antidepressants in the treatment of painful physical symptoms associated with depression and the treatment of pain in nondepressed patients. The authors focus on published data for the antidepressant duloxetine and set out to determine "whether, in fact, there is a role for duloxetine in chronic pain management." 1(p118) We wish to reply to the points raised in the article, clarify some of the statements made by the authors, and add new data that were not in the public domain at the time of submission of the article.Collectively, these new results support the following conclusions: (1) duloxetine is an antidepressant that effectively treats painful physical symptoms in depressed patients 2-4 ; (2) alleviation of painful physical symptoms in depressed patients significantly increases these patients' probability of achieving remission 5 ; (3) approximately 50% of duloxetine's effect on pain in depressed patients occurs independently of changes in core emotional symptoms of depression (M. Fava, M.D.; C. H. Mallinckrodt, Ph.D.; M.M.W., et al., manuscript submitted); and (4) duloxetine effectively treats pain associated with diabetic neuropathy in nondepressed patients. 6 First and foremost, duloxetine is an effective antidepressant. While some studies have investigated duloxetine's efficacy in pain states, the primary focus of our clinical development program has been the treatment of major depressive disorder (MDD). Results from doubleblind, placebo-controlled studies, [2][3][4]7 in addition to a longterm, open-label study, 8 have established duloxetine as a safe and effective treatment for MDD. Leo and Barkin state that "its [duloxetine's] efficacy in reducing severity of depression . . . is comparable to that of antidepressants of the selective serotonin reuptake inhibitor (SSRI) class, e.g., paroxetine and fluoxetine." 1(p118) In fact, an analysis of pooled data from comparator-controlled studies has shown that, in patients with a baseline 17-item Hamilton Rating Scale for Depression score of ≥ 19, remission rates for duloxetine are significantly higher than those for the SSRI comparators paroxetine and fluoxetine. 9 Duloxetine is a balanced and potent reuptake inhibitor of both serotonin and norepinephrine. In addition to their role in the neurobiology of depression, these neurotransmitters act as pain modulators in the descending pain pathways of the spinal cord. 10 In placebo-controlled studies, duloxetine has demonstrated efficacy in the treatment of painful physical symptoms in depressed patients, as assessed using visual analog scales for pain. [2][3][4] The authors correctly state that in the studies conducted to date, the nature of the pain complaints was not established, nor was the etiology of the pain. Patients were required to meet DSM-IV criteria for MDD, but were not screened for the presence or severity of pain. The rationale behind this was straightforward. The clinical studies were design...

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Efficacy of duloxetine, a potent and selective 5-HT/NE reuptake inhibitor, in rat models of persistent and neuropathic pain

Cited by 2 publications

References 0 publications

Antidepressant Use in Chronic Pain Management

Antidepressant Use in Chronic Pain Management

The Role of Duloxetine in the Treatment of Depression and Associated Painful Physical Symptoms

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