Duloxetine in the Treatment of Carpal Tunnel Syndrome: A Pilot Randomized Clinical Trial Study

Document Type : Original Article (s)

Authors

1 Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Specialist in Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Carpal tunnel syndrome (CTS) is one of the most common neuropathies in the upper extremity. This study aimed to evaluate the effect of duloxetine in the treatment of carpal tunnel syndrome.Methods: This pilot study was done as a clinical trial on 24 patients with carpal tunnel syndrome in two groups of duloxetine and control. Patients in both group received routine treatment during study period. In week 3, patients in duloxetine group received duloxetine capsules for one month. Pain score, symptom severity scale (SSS), functional status scale (FSS), and carpal tunnel syndrome severity score and adverse effects as the main study outcomes were measures and compared at baseline, end of week 6, and end of week 12.Findings: The mean pain score at the end of weeks 6 and 12 was significantly lower in duloxetine group compared to control group (P < 0.050). The symptom severity scale was similar between both groups (P > 0.050). Decreasing trend of functional status scale in control patients was higher than duloxetine group during study period (P = 0.028). At the end of week 12, functional status scale in control was lower than duloxetine group (P = 0.010). At the end of study, the carpal tunnel syndrome severity score was significantly lower in duloxetine group compared to control group (P = 0.012).Conclusion: Adding duloxetine to routine treatment in patients with carpal tunnel syndrome can be effective to decrease pain severity, and improve patient’s function; although, more investigations are necessary due to small sample size of the present study.

Keywords


  1. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J 2008; 77(1): 6-17.
  2. de Krom MC, van Croonenborg JJ, Blaauw G, Scholten RJ, Spaans F. Guideline 'Diagnosis and treatment of carpal tunnel syndrome'. Ned Tijdschr Geneeskd 2008; 152(2): 76-81. [In Dutch].
  3. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282(2): 153-8.
  4. Stevens JC, Sun S, Beard CM, O'Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology 1988; 38(1): 134-8.
  5. Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med 2011; 171(10): 943-4.
  6. Gelfman R, Melton LJ 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology 2009; 72(1): 33-41.
  7. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45(4): 373-6.
  8. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil 2007; 21(4): 299-314.
  9. Scholten RJ, Mink van der Melon A, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; (4): CD003905.
  10. Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: A systematic review. J Hand Ther 2004; 17(2): 210-28.
  11. Schuessler B. What do we know about duloxetine's mode of action? Evidence from animals to humans. BJOG 2006; 113(Suppl 1): 5-9.
  12. Bellingham GA, Peng PW. Duloxetine: a review of its pharmacology and use in chronic pain management. Reg Anesth Pain Med 2010; 35(3): 294-303.
  13. Armstrong EP, Malone DC, Erder MH. A Markov cost-utility analysis of escitalopram and duloxetine for the treatment of major depressive disorder. Curr Med Res Opin 2008; 24(4): 1115-21.
  14. Goldstein DJ. Duloxetine in the treatment of major depressive disorder. Neuropsychiatr Dis Treat 2007; 3(2): 193-209.
  15. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015; 14(2): 162-73.
  16. Stevens JC. AAEM minimonograph #26: The electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 1997; 20(12): 1477-86.
  17. Battaglini E, Park SB, Barnes EH, Goldstein D. A double blind, placebo controlled, phase II randomised cross-over trial investigating the use of duloxetine for the treatment of chemotherapy-induced peripheral neuropathy. Contemp Clin Trials 2018; 70: 135-8.
  18. Gao Y, Guo X, Han P, Li Q, Yang G, Qu S, et al. Treatment of patients with diabetic peripheral neuropathic pain in China: a double-blind randomised trial of duloxetine vs. placebo. Int J Clin Pract 2015; 69(9): 957-66.
  19. Roy MK, Kuriakose AS, Varma SK, Jacob LA, Beegum NJ. A study on comparative efficacy and cost effectiveness of Pregabalin and Duloxetine used in diabetic neuropathic pain. Diabetes Metab Syndr 2017; 11(1): 31-5.
  20. Nemeroff CB, Schatzberg AF, Goldstein DJ, Detke MJ, Mallinckrodt C, Lu Y, et al. Duloxetine for the treatment of major depressive disorder. Psychopharmacol Bull 2002; 36(4): 106-32.
  21. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy or chronic pain. Cochrane Database Syst Rev 2009; (4): CD007115.
  22. Wright A, Luedtke KE, Vandenberg C. Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy. J Pain Res 2010; 4: 1-10.