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Combination of pregabalin with duloxetine for fibromyalgia

a randomized controlled trial

Gilron, Iana,b,i,*; Chaparro, Luis E.c; Tu, Dongshengd,e; Holden, Ronald R.f; Milev, Roumeng; Towheed, Tanveerh; DuMerton-Shore, Deborahi; Walker, Sarahi

doi: 10.1097/j.pain.0000000000000558
Research Paper

Fibromyalgia is a syndrome characterized by chronic widespread pain and associated with sleep disturbance, depression, fatigue, and cognitive dysfunction. Polypharmacy is commonly used, but supportive evidence is limited. Most fibromyalgia trials focus primarily on pain reduction with monotherapy. This trial compares a pregabalinduloxetine combination to each monotherapy. Using a randomized, double-blind, 4-period crossover design, participants received maximally tolerated doses of placebo, pregabalin, duloxetine, and pregabalinduloxetine combination—for 6 weeks. Primary outcome was daily pain (0-10); secondary outcomes included global pain relief, Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. Of 41 participants randomized, 39 completed ≥2 treatments. Daily pain during placebo, pregabalin, duloxetine, and combination was 5.1, 5.0, 4.1, and 3.7, respectively (P < 0.05 only for combination vs placebo, and pregabalin). Participants (%) reporting ≥moderate global pain relief were 18%, 39%, 42%, and 68%, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). Fibromyalgia Impact Questionnaire scores were 42.9, 37.4, 36.0, and 29.8, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). SF-36 scores were 50.2, 55.7, 56.0, and 61.2, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). Medical Outcomes Study Sleep Scale scores were 48.9, 35.2, 46.1, and 32.1, respectively (P < 0.05 only for combination vs placebo, and duloxetine). BDI-II scores were 11.9, 9.9, 10.7, and 8.9, respectively (P < 0.05 only for combination vs placebo). Moderate–severe drowsiness was more frequent during combination vs placebo. Combining pregabalin and duloxetine for fibromyalgia improves multiple clinical outcomes vs monotherapy. Continued research should compare this and other combinations to monotherapy for fibromyalgia.

This double-blind randomized controlled trial demonstrates improved outcomes with a duloxetinepregabalin combination over either single drug for fibromyalgia.

Departments of aAnesthesiology and Perioperative Medicine and

bBiomedical and Molecular Sciences, Queen's University, Kingston, Canada

cUniversity of Toronto, Department of Anesthesia, University of Toronto, Toronto, Canada

dPublic Health Sciences

eMathematics and Statistics

fPsychology and

gPsychiatry, Queen's University, Kingston, Canada

hDivision of Rheumatology, Department of Medicine Queen's University, Kingston, ON, Canada

iDepartment of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada

Corresponding author. Address: Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Providence Care, St. Mary's of the Lake Hospital, Queen's University, 76 Stuart St, Kingston, ON K7L 2V7, Canada. Tel: 613-548-7827; fax: 613-548-1375. E-mail address: (I. Gilron).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received December 30, 2015

Received in revised form March 03, 2016

Accepted March 07, 2016

© 2016 International Association for the Study of Pain
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