Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
OBJECTIVE: The objective of this selective EBM review is to determine whether or not duloxetine is effective in reducing pain for patients with diabetic neuropathy.
STUDY DESIGN: Systematic review of three English language Randomized Controlled Trials, published between 2010-2015.
DATA SOURCES: Three randomized controlled trials published in peer-reviewed journals comparing the effects of Duloxetine on diabetic neuropathy pain found using the Embase database.
OUTCOME MEASURES: The outcomes were measured by assessing diabetic neuropathy pain reduction, using the Brief Pain Inventory (BPI) average pain item, BPI- severity scale, BPI- interference. Also, individual health outcome was measured by using Patient Global Impression of Improvement (PGI)- Improvement scale, Sheehan Disability Scale (SDS), and Clinical Global Impressions of Severity (CGI-S).
RESULTS: Three studies in the review showed a significant pain reduction for patients with the diabetic neuropathic pain taking a duloxetine vs. a placebo. However, Gao and co-authors showed no statistically different mean change in BPI average pain reduction from baseline to endpoint between the treatment groups in week 8 (p= 0.125) and 12 (p=0.107). The other two studies showed the statistical significance of primary efficacy results as “p” <0.0001 and “p”= 0.030. All three studies showed significant health outcome measured in BPI-interference and NNT.
CONCLUSIONS: There is a significant benefit of using duloxetine for the diabetic neuropathic pain vs. placebo. The most common adverse effect of Duloxetine is nausea, which may discourage the usage and its therapeutic benefit in pain reduction for diabetic neuropathic pain (DNP). Further investigation in the long-term study will reinforce the efficacy and safety of duloxetine as the diabetic neuropathic pain treatment.
Namgoong, Hee, "Is duloxetine effective in reducing pain for patients with diabetic neuropathy?" (2018). PCOM Physician Assistant Studies Student Scholarship. 372.