Diabetic neuropathic pain is a nerve disorder that is specifically caused by the condition of diabetes. Sometimes the neuropathy does not present with symptoms but usually patients may have pain in their feet, legs, arms or hands. In less severe cases this may be a tingling sensation or the patient may feel that the affected part of the body is numb.
Neuropathic pain is a pain that results from a damaged nervous system where pain is produced by the damaged nervous system and transmitted to the brain.
It is different from nociceptive pain which is the pain that is produced as a result of trauma or direct injury. Duloxetine is a drug that is licensed for use in treating clinical depression as well as urinary incontinence that is caused by stress and it can also be useful in treating diabetic neuropathic pain, which is why it was identified as being potentially useful in treating other neuropathic conditions.
Authors' conclusions: There is moderately strong evidence that duloxetine 60 mg and mg daily are efficacious for treating pain in diabetic peripheral neuropathy and fibromyalgia but 20 mg daily is not. Minor side effects are common at therapeutic doses but serious side effects are rare. Direct comparisons of duloxetine with other antidepressants and with other drugs already shown to be efficacious in neuropathic pain would be appropriate and should include unbiased economic analyses.
We identified 18 trials, which included participants. We found 12 of these studies in the literature search for this update. Eight studies included a total of participants with painful diabetic neuropathy and six studies involved participants with fibromyalgia.
Three studies included participants with depression and painful physical symptoms and one included participants with central neuropathic pain. Studies were mostly at low risk of bias, although significant drop outs, imputation methods and almost every study being performed or sponsored by the drug manufacturer add to the risk of bias in some domains.
There was no effect on central neuropathic pain in a single, small, high quality trial. In all conditions, adverse events were common in both treatment and placebo arms but more common in the treatment arm, with a dose-dependent effect. Most adverse effects were minor, but Serious adverse events were rare.
Review question Does duloxetine work to treat pain generated by nerves when they have been damaged in disease, or the pain caused by fibromyalgia?
Background Duloxetine is a drug used to treat depression and urinary urge incontinence leakage of urine and it can be also be useful for certain types of pain. Study characteristics We looked at all the published scientific literature and found 18 trials, involving a total of participants, that were of sufficient quality to include in this review.
Key results and quality of the evidence The usual dose of duloxetine is 60 mg. Authors' conclusions:. Search strategy:. You can take duloxetine with or without food, but it's best to take it at the same time each day. For depression, anxiety and nerve pain, duloxetine comes in 30mg and 60mg capsules.
For stress urinary incontinence, duloxetine comes in 20mg and 40mg capsules. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine. The amount of duloxetine that can lead to an overdose varies from person to person. Take the duloxetine packet or the leaflet inside it, plus any remaining medicine, with you. Like all medicines, duloxetine can cause side effects in some people. But most people have no side effects or only minor ones.
Some of the common side effects of duloxetine will gradually improve as your body gets used to it. In rare cases, it's possible to have a serious allergic reaction anaphylaxis to duloxetine. You could be having a serious allergic reaction and may need immediate treatment in hospital. You can report any suspected side effect to the UK safety scheme. It's important for you and your baby that you stay well during your pregnancy.
There's no firm evidence that duloxetine is harmful to an unborn baby. But for safety, pregnant women are usually advised to only take it if the benefits of the medicine outweigh the potential risks. If you become pregnant while taking duloxetine, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
If you need to take duloxetine during pregnancy to remain well, your doctor can explain the risks and the benefits to help you decide which treatment is best for you and your baby. For more information about how duloxetine can affect you and your baby during pregnancy, read the leaflet on the best use of medicines in pregnancy BUMPS website.
If your doctor or health visitor says your baby is healthy, duloxetine may be used during breastfeeding. Duloxetine passes into breast milk in very small amounts, but it's not known if it's harmful to the baby. It's important to continue taking duloxetine to keep you well. Breastfeeding will also benefit both you and your baby. If you notice that your baby's not feeding as well as usual or seems unusually sleepy, or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
Some medicines and duloxetine can interfere with each other and increase the chances of you having side effects. Do not take the herbal remedy St John's wort while you're being treated with duloxetine, as this will increase your risk of side effects. Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
Duloxetine is a type of antidepressant known as a serotonin-noradrenaline reuptake inhibitor SNRI. SNRIs are thought to work by increasing the amount of mood-enhancing chemicals serotonin and noradrenaline in the brain. You may see an improvement after 2 to 4 weeks. Improvements for nerve pain may take longer. Do not stop taking duloxetine after a week or two just because you feel it's not helping your symptoms.
Antidepressants like duloxetine help to gradually lift your mood so you feel better. You may notice that you sleep better and get on with people more easily because you're less anxious.
Do not expect to feel better overnight, though.
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