False conclusions regarding duloxetine's purported efficacy in pain among depressed patients.

A recent narrative review by Mohr et al. (2010) states that duloxetine possesses “consistent analgesic efficacy” in reducing pain among depressed patients. They claim that this finding runs counter to my allegedly “controversial” meta-analysis which found that duloxetine possessed no such analgesic benefits in depression (Spielmans 2008). Yet their paper did not contain any statistical analysis of the underlying data; rather, they performed what appears to be an incomplete literature review. My meta-analysis included five placebo-controlled trials of duloxetine for treating pain in depression (Spielmans 2008), whereas their more recent paper mentioned only three such trials. So, based on fewer studies and without the benefit of any statistical analysis, Mohr et al. (2010) decreed that duloxetine possesses analgesic properties for depressed patients. My report, based on a meta-analysis of five controlled trials, found only a very small, nonstatistically significant effect for duloxetine. I believe the educated reader can easily ascertain which analysis is more valid. One is left to wonder if the fact that duloxetine’s sponsor, Eli Lilly, “supported the work” of the authors had any influence on their incomplete literature review or invalid interpretation of the evidence regarding duloxetine as a treatment for pain in depression.