Review ArticlesDuloxetine in Painful Diabetic Neuropathy A Systematic ReviewHossain, Sultana Mehbuba BPharm, MSPharm Tech*; Hussain, Sultana Monira MBBS, MPH, PhD†; Ekram, A.R.M.S. MBBS, FCPS, FACP, FRCP‡Author Information *Department of Pharmacy, University of Asia Pacific, Dhaka ‡Rajshahi Medical College, Rajshahi University, Rajshahi, Bangladesh †School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic, Australia S.M.H. is the recipient of AFA-ARA Heald Fellowship by Arthritis Australia Foundation. S.Me.H. and S.Mo.H.: involved in conception and design of the study. S.Me.H.: involved in statistical analysis and interpretation of the data, and drafted the manuscript. S.Mo.H.: involved in cleaning and merging the datasets and interpretation of the data. S.Me.H., S.Mo.H., and A.R.M.S.E.: involved in the interpretation of the data. All authors reviewed the manuscript and approved the final manuscript. All authors had full access to all of the data in the study. The authors declare no conflict of interest. Reprints: A.R.M. S. Ekram, MBBS, FCPS, FACP, FRCP, Department of Medicine, Rajshahi Medical College, Rajshahi-6000, Bangladesh (e-mail: email@example.com). The Clinical Journal of Pain: November 2016 - Volume 32 - Issue 11 - p 1005-1010 doi: 10.1097/AJP.0000000000000343 Buy Metrics Abstract Objective: To systematically review the evidence for duloxetine in the management of painful diabetic neuropathy (PDN). Methods: Electronic searches of Medline and PubMed were performed from 2005 till October 2015 using medical subject headings and free-text words. Two independent reviewers extracted the data and assessed the methodological quality of the selected studies. Results: Twenty-three studies met our inclusion criteria and 8 were considered of high quality and were included to this review. Because of heterogeneity of the studies included in this review, statistical pooling of the data was not possible. We found good evidence for use of duloxetine in PDN over placebo and pregabalin but there was no benefit of duloxetine over amitriptyline. Conclusions: Duloxetine has a beneficial effect over placebo. Nevertheless, the evidence of superiority of duloxetine over pregabalin and amitriptyline should be explored further as there was only 1 trial for each category. Provided majority of the PDN patients share cardiovascular complications, use of duloxetine will be a good option for treating pain associated with PDN over amitriptyline. Future randomized controlled trials should be designed keeping this in mind. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.