Comparative pain and mood effects in patients with comorbid fibromyalgia and major depressive disorder: secondary analyses of four pooled randomized controlled trials of duloxetine.

Abstract

The objective of this paper is to better understand the relationship of pain and mood in patients with fibromyalgia and comorbid major depressive disorder (MDD). Pooled data from 4 double-blind, placebo-controlled, randomized trials of duloxetine hydrochloride 60-120mg/day in patients with fibromyalgia were included (N=1332). Of these, 350 (26% [147 placebo, 203 duloxetine]) had comorbid MDD (per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria) and were included in these analyses. Primary measures included Brief Pain Inventory average pain; Hamilton Depression Rating Scale or Beck Depression Inventory. Logistic regression was used to evaluate the consistency of treatment effect across various subgroups. Path analysis was used to assess the effect of duloxetine on improvement in pain in the presence of improvement in mood and vice versa. Results indicated that 69% of improvement in pain was a direct effect of treatment, with improvement in mood accounting for 31% of pain response. In conclusion, consistent with our hypothesis, duloxetine produced a substantial direct effect on pain improvement and change in mood exerted a modest indirect effect on pain improvements in patients with fibromyalgia and MDD. Hence, both direct and indirect analgesic and antidepressant properties appear to be relevant for the treatment of these comorbid patients with duloxetine.

• Authors: Lauren B Marangell, Daniel J Clauw, Ernest Choy, Fujun Wang, Scarlett Shoemaker, Laurence Bradley, Philip Mease, Madelaine M Wohlreich
• Journal: Pain (Pain) Vol. 152 Issue 1 Pg. 31-37 (Jan 2011) ISSN: 1872-6623 [Electronic] United States
• PMID: 20598442 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Chemical References

• Antidepressive Agents
• Thiophenes
• Duloxetine Hydrochloride

Topics

• Adult
• Affect (drug effects)
• Antidepressive Agents (therapeutic use)
• Comorbidity
• Depressive Disorder, Major (complications, drug therapy, epidemiology)
• Double-Blind Method
• Duloxetine Hydrochloride
• Female
• Fibromyalgia (complications, drug therapy, epidemiology)
• Humans
• Male
• Middle Aged
• Pain (etiology)
• Pain Measurement
• Psychiatric Status Rating Scales
• Randomized Controlled Trials as Topic
• Severity of Illness Index
• Thiophenes (therapeutic use)