Papers of the Week

The objective of this systematic review was to assess the analgesic efficacy of duloxetine (DLX) for fibromyalgia (FM) and find which dosage between 60mg/d DLX and 120mg/d DLX was more suitable for clinical application. A systematic search through multiple databases (Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest, Pubmed) was conducted from 2000 until March 7, 2019. All steps were performed by two or more independent reviewers. A meta-analysis was performed to report the effects of DLX on pain reduction and its accompanied adverse events. This meta-analysis, including 7 studies with totaling 2642 FM patients, demonstrated that DLX could produce greater pain relief in FM than placebo (standardized mean difference (SMD) -0.26; 95% confidence interval (CI) -0.37 to -0.16). The Risk Ratio (RR) of at least 30% pain relief was 1.31(95%CI 1.19 to 1.44); The RR of at least 50% pain relief was 1.46 (95% CI 1.28 to 1.67). However, the adverse events were more common in patients with DLX than the ones with placebo (RR 1.17, 95%CI 1.12 to 1.23). The subgroup analyses of withdrawal effects demonstrated that 120mg/d DLX had a higher incidence (RR 0.96, 95% CI 0.80 to 1.15) than 60mg/d DLX (RR 0.77, 95% CI 0.63 to 0.93). In general, DLX was a great choice for pain relief in FM. Moreover, 60mg/d DLX produced less withdrawal effects than 120mg/d DLX. Highlight Fibromyalgia(FM) is a chronic condition of unknown etiology, characterized by widespread pain and often associated with other symptoms. Duloxetine (DLX), a serotonin-norepinephrine (noradrenaline) reuptake inhibitor(SNRI), is used to treat FM in many countries. DLX can produce greater pain relief in FM than placebo. DLX can bring about more adverse events than placebo. 60mg/d DLX produce less withdrawal than 120mg/d DLX for FM patients.