Duloxetine in OsteoArthritis (DOA) study: effects of duloxetine on pain and function in end-stage hip and knee OA - a pragmatic enriched randomized controlled trial

被引：10

作者：

Blikman, T. ^{[1
,2
]}

Rienstra, W. ^{[1
,2
]}

van Raaij, T. M. ^{[3
]}

Ten Hagen, A. J. ^{[4
]}

Dijkstra, B. ^{[5
]}

Zijlstra, W. P. ^{[5
]}

Bulstra, S. K. ^{[1
]}

Stevens, M. ^{[1
]}

van den Akker-Scheek, I ^{[1
]}

机构：

[1] Univ Groningen, Univ Med Ctr Groningen, Dept Orthoped, POB 30001, NL-9700 Groningen, Netherlands

[2] Univ Groningen, Univ Med Ctr Groningen, Dept Rehabil Med, POB 30001, NL-9700 Groningen, Netherlands

[3] Martini Hosp Groningen, Dept Orthoped, Groningen, Netherlands

[4] Martini Hosp Groningen, Dept Anaesthesiol, Groningen, Netherlands

[5] Med Ctr Leeuwarden, Dept Orthoped, Leeuwarden, Netherlands

来源：

BMC MUSCULOSKELETAL DISORDERS | 2022年 / 23卷 / 01期

关键词：

Duloxetine; Osteoarthritis; Hip; Knee; Pain; NEUROPATHIC PAIN; DOUBLE-BLIND; MANAGEMENT; VALIDATION; PAINDETECT; EFFICACY; SAFETY; SCALE; RECOMMENDATIONS; CLASSIFICATION;

D O I：

10.1186/s12891-022-05034-0

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background: Some osteoarthritis (OA) patients experience inadequate pain relief from analgesics like acetaminophen and nonsteroidal anti-inflammatory drugs. This could be the result of experienced non-nociceptive centralized pain. Placebo-controlled randomized trials (RCT) have proven the effectiveness of duloxetine for OA and several chronic pain conditions where central sensitization (CS) is one of the key underlying pain mechanisms. Objectives: Assess the efficacy of an 8-week duloxetine treatment compared to usual care in end-stage knee and hip OA patients with a level of centralized pain. Design: Pragmatic, enriched, open-label RCT. Methods: Patients were randomized to duloxetine or to care-as-usual. Primary outcome was pain in the index joint, measured with the pain domain of the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Hip disability and Osteoarthritis Outcome Score (HOOS). The intention-to-treat principle was used, with mixed-model repeated measures to analyze the effect. Results: One hundred eleven patients were randomized. Nearly 44% felt much to very much better after duloxetine usage compared to 0% in the care-as-usual group (p < 0.001). The duloxetine group scored 11.3 points (95%CI: 5.8, 16.8) better on the pain domain of the KOOS/HOOS (p < 0.001). Knee patients improved significantly more than hip patients (18.7 [95%CI: 11.3, 26.1] versus 6.0 [95%CI: -2.6, 14.5] points better). Conclusions: Adding duloxetine treatment seems to be beneficial for end-stage knee OA patients with neuropathic-like symptoms (at risk of CS). End stage Hip OA patients seem to be nonresponsive to duloxetine.

引用

页数：14