Objective:

We conducted this systematic review and meta-analysis to evaluate the role of duloxetine in pain reduction and enhancing the quality of life for individuals with chronic low back pain (CLBP). Additionally, we explored whether depression might influence the treatment response, serving as a potential treatment modifier.

Background:

In patients with CLBP, around 37% exhibit symptoms associated with neuropathic pain, specifically radicular pain. Effectively managing this condition continues to be a significant challenge.

Design/Methods:

We searched five databases to find randomized controlled trials (RCTs) assessing the effectiveness of duloxetine for CLBP. The primary outcomes included pain reduction using the Visual Analogue Scale (VAS) and the Brief Pain Inventory (BPI), and evaluating improvements in quality of life using the Short Form 36 (SF-36). Two independent reviewers carried out data extraction and assessed the risk of bias. Effect estimates were combined using a meta-analysis model. Heterogeneity, sensitivity analysis, and subgroup analysis were performed to investigate potential sources of variation.

Results:

Nine RCTs (3209 participants) were included in the meta-analysis. Duloxetine demonstrated significant  pain reduction using VAS (mean difference (MD): -2.12, 95% CI: [-2.38 to -1.85], P<0.0001) and BPI (MD: -0.51, 95% CI: [-0.85 to -0.17], P=0.003) compared to placebo. The total SF-36 score also showed a significant improvement in quality of life with duloxetine (MD: 3.63, 95% CI: [1.74 to 5.52], P= 0.0002). Subgroup analysis indicated that depression influenced the treatment response, with greater pain regression observed in depressed CLBP patients. Serious adverse events were comparable between the compared groups (P= 0.49).

Conclusions:

Our research showed promising findings concerning the role of duloxetine in reducing back pain and enhancing the quality of life. Despite recognizing limitations such as heterogeneity and a limited number of studies, our results endorse the safety and efficacy of duloxetine in addressing chronic low back pain, especially in individuals dealing with depression.