Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper treatment with high efficacy and low side effects. In this study, we evaluated the efficacy of duloxetine and gabapentin in patients with moderate to severe knee OA.
In this randomized clinical trial, 150 patients with moderate to severe knee OA were randomly allocated to receive duloxetine 30 mg (n = 50), gabapentin 300 mg (n = 50), or acetaminophen 1000 mg (n = 50) all twice a day for 12 weeks. Pain severity using visual analogue scale (VAS) and functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured before, 2 weeks, 1 month, and 3 months after intervention.
WOMAC total and its subscale score were significantly lower in duloxetine compared to gabapentin in 2 weeks and 1 months after intervention, with no significant difference at the end of the third month. Both gabapentin and duloxetine groups had significantly more reduction in pain VAS and WOMAC and its subscales compared to acetaminophen group, with no significant difference between groups.
Both gabapentin and duloxetine have similar and acceptable effects in pain reduction and improvement of functional status in patients with knee OA at the end of the third month’s treatment. Duloxetine effects begin from the first weeks, while gabapentin effects begin gradually with the best at the end of the third month.
• Medical treatment is used for releiving pain in knee osteoarthritis.
• Gabapentin and duloxetine are both effective in reducing pain in knee osteoarthritis.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Micca JL, Ruff D, Ahl J, Wohlreich MM (2013) Safety and efficacy of duloxetine treatment in older and younger patients with osteoarthritis knee pain: a post hoc, subgroup analysis of two randomized, placebo-controlled trials. BMC Musculoskelet Disord 2013 14:137
Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM et al (2005) Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 13:635–646
Bijlsma JW, Berenbaum F, Lafaber FP (2011) Osteoarthritis: an update with relevance for clinical practice. Lancet 18:2115–2126
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM et al (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil 22:363–388
Woolf CJ (2004) Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 140:441–451
Kidd BL, Urban LA (2001) Mechanisms of inflammatory pain. Br J Anaesth 87:3–11
Raskin J, Pritchett YL, Wang F, D'Souza DN, Waninger AL, Iyengar S, Wernicke JF (2005) A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med 6:346–356
Wernicke JF, Pritchett YL, D'Souza DN, Waninger A, Tran P, Iyengar S, Raskin J (2006) A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology 67:1411–1420
Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S, Goldstein DJ, Duloxetine Fibromyalgia Trial Group (2004) A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 50:2974–2984
Russell JI, Mease PJ, Smith TR, Kajdasz DK, Wohlreich MM, Detke MJ, Walker DJ, Chappell AS, Arnold LM (2008) Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 136:432–444
Skljarevski V, Ossanna MJ, Liu-Seifert H, Zhang Q, Chappell A, Iyengar S, Detke M, Backonja M (2009) A double-blind, randomized trial of duloxetine versus placebo in the management of chronic low back pain. Eur J Neurol 16:1041–1048
Skljarevski V, Zhang S, Desaiah D, Alaka KJ, Palacios S, Miazgowski T, Patrick K (2010) Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed dose, randomized, double-blind trial. J Pain 11:1282–1290
Chappell AS, Ossanna MJ, Liu-Seifert H, Iyengar S, Skljarevski V, Li LC, Bennett RM, Collins H (2009) Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain: a 13-week, randomized, placebo-controlled trial. Pain 146:253–260
Chappell AS, Desaiah D, Liu-Seifert H, Zhang S, Skljarevski V, Belenkov Y, Brown JP (2011) A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment chronic pain due to osteoarthritis of the knee. Pain Pract 11:33–41
Myers J, Wielage RC, Han B, Price K, Gahn J, Paget MA, Happich M (2014) The efficacy of duloxetine, non-steroidal anti-inflammatory drugs, and opioids in osteoarthritis: a systematic literature review and meta-analysis. BMC Musculoskelet Disord 15:76
Park J, Yu YP, Zhou CY, Li KW, Wang D, Chang E, Kim DS, Vo B, Zhang X, Gong N, Sharp K, Steward O, Vitko I, Perez-Reyes E, Eroglu C, Barres B, Zaucke F, Feng G, Luo ZD (2016) Central mechanisms mediating thrombospondin-4-induced pain states. J Biol Chem 291:13335–13348
Pan B, Guo Y, Wu HE, Park J, Trinh VN, Luo ZD, Hogan QH (2016) Thrombospondin-4 divergently regulates voltage-gated Ca2+ channel subtypes in sensory neurons after nerve injury. Pain 157:2068–2080
Moore RA, Wiffen PJ, Derry S, McQuay HJ (2011) Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 3:CD007938
Calandre EP, Rico-Villademoros F, Slim M (2016) Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use. Expert Rev Neurother 16:1263–1277
Adães S, Ferreira-Gomes J, Mendonça M, Almeida L, Castro-Lopes JM, Neto FL (2015) Injury of primary afferent neurons may contribute to osteoarthritis induced pain: an experimental study using the collagenase model in rats. Osteoarthr Cartil 23:914–924
Gong K, Shao W, Chen H, Wang Z, Luo ZJ (2011) Rat model of lumbar facet joint osteoarthritis associated with facet-mediated mechanical hyperalgesia induced by intra-articular injection of monosodium iodoacetate. J Formos Med Assoc 110:145–152
Rudroju N, Bansal D, Talakokkula ST, Gudala K, Hota D, Bhansali A et al (2013) Comparative efficacy and safety of six antidepressants and anticonvulsants in painful diabetic neuropathy: a network meta-analysis. Pain Physician 16:E705–E714
Arreola Ornelas H, Rosado Buzzo A, García L, Dorantes Aguilar J, Contreras Hernández I, Mould Quevedo JF (2012) Cost-effectiveness analysis of pharmacologic treatment of fibromyalgia in Mexico. Reumatol Clin 8:120–127
Andrews JS, Wu N, Chen SY, Yu X, Peng X, Novick D (2013) Real-world treatment patterns and opioid use in chronic low back pain patients initiating duloxetine versus standard of care. J Pain Res 6:825–835
Nash RJ, Azantsa BK, Sharp H, Shanmugham V (2018) Effectiveness of Cucumis sativus extract versus glucosamine-chondroitin in the management of moderate osteoarthritis: a randomized controlled trial. Clin Interv Aging 13:2119–2126. https://doi.org/10.2147/CIA.S173227
Eftekharsadat B, Babaei-Ghazani A, Habibzadeh A, Kolahi B (2015) Efficacy of action potential simulation and interferential therapy in the rehabilitation of patients with knee osteoarthritis. Ther Adv Musculoskelet Dis 7:67–75
Nadrian H, Moghimi N, Nadrian E, Moradzadeh R, Bahmanpour K, Iranpour A, Bellamy N (2012) Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index. Clin Rheumatol 31:1097–1102
Mora JC, Przkora R, Cruz-Almeida Y (2018) Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res 11:2189–2196
Jevsevar DS (2013) Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 21:571–576
Bindawas SM, Vennu V, Al Snih S (2015) Differences in health-related quality of life among subjects with frequent bilateral or unilateral knee pain: data from the Osteoarthritis Initiative study. J Orthop Sports Phys Ther 45:128–136
Eftekharsadat B, Babaei-Ghazani A, Habibzadeh A (2015) The efficacy of 100 and 300 mg gabapentin in the treatment of carpal tunnel syndrome. Iran J Pharm Res 14:1275–1280
Wang G, Bi L, Li X, Li Z, Zhao D, Chen J, He D, Wang CN, Dueñas H, Skljarevski V, Yue L (2017) Efficacy and safety of duloxetine in Chinese patients with chronic pain due to osteoarthritis: a randomized, double-blind, placebo-controlled study. Osteoarthr Cartil 25:832–838
Vonsy JL, Ghandehari J, Dickenson AH (2009) Differential analgesic effects of morphine and gabapentin on behavioural measures of pain and disability in a model of osteoarthritis pain in rats. Eur J Pain 13:786–793
Uchio Y, Enomoto H, Alev L, Kato Y, Ishihara H, Tsuji T, Ochiai T, Konno S (2018) A randomized, double-blind, placebo-controlled phase III trial of duloxetine in Japanese patients with knee pain due to osteoarthritis. J Pain Res 11:809–821
Wang ZY, Shi SY, Li SJ, Chen F, Chen H, Lin HZ, Lin JM (2015) Efficacy and safety of duloxetine on osteoarthritis knee pain: a meta-analysis of randomized controlled trials. Pain Med 16:1373–1385
Sofat N, Harrison A, Russell MD, Ayis S, Kiely PD, Baker EH, Barrick T, Howe F (2017) The effect of pregabalin or duloxetine on arthritis pain: a clinical and mechanistic study in people with hand osteoarthritis. J Pain Res 10:2437–2449
Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T et al (2017) Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev 6:CD007938
The study was conducted in accordance with the Declaration of Helsinki and good clinical practice guidelines and with local requirements.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Enteshari-Moghaddam, A., Azami, A., Isazadehfar, K. et al. Efficacy of duloxetine and gabapentin in pain reduction in patients with knee osteoarthritis. Clin Rheumatol 38, 2873–2880 (2019). https://doi.org/10.1007/s10067-019-04573-7
- Knee osteoarthritis