Antidepressants for pain management in adults with chronic pain: a network meta-analysis
Worth asking your prescriber whether 60 mg is sufficient if a dose increase is being considered for pain, since higher duloxetine doses showed no added benefit in this analysis.
Top of the evidence hierarchy, independently funded. how we score evidence
Caveat on this rating: Of 146 included studies reporting funding, 72 were funded by pharmaceutical companies; safety evidence was rated very low certainty.
Across 176 trials with 28,664 adults with chronic pain, standard-dose duloxetine (60 mg) was the highest-ranked antidepressant, roughly doubling the odds of substantial (50% or greater) pain relief versus placebo (odds ratio 1.91, 95% CI 1.69 to 2.17, moderate-certainty evidence), and higher doses were no better than 60 mg for most outcomes.
Worth asking
Worth asking your prescriber whether 60 mg is sufficient if a dose increase is being considered for pain, since higher duloxetine doses showed no added benefit in this analysis.
What it is FDA approved for
Read off the label. Trial duration and approval year are shown only where they were recorded — never inferred.
- Major depressive disorder (adults)
- Generalized anxiety disorder (adults and pediatric patients 7 years and older)
- Diabetic peripheral neuropathic pain (adults)
- Fibromyalgia (adults and pediatric patients 13 years and older)
- Chronic musculoskeletal pain (adults)
Source
Antidepressants for pain management in adults with chronic pain: a network meta-analysis — Birkinshaw H, et al. (2023)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1002/14651858.CD014682.pub2
DOI: 10.1002/14651858.CD014682.pub2
How this was scored
- Study design
- Meta-analysis of randomised trials
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 28,664
- Preregistered
- Yes
- Conflicts disclosed
- No
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "gold standard". Top of the evidence hierarchy, independently funded. It scores 91 out of 100 on our published rubric. One caveat travels with that badge: Of 146 included studies reporting funding, 72 were funded by pharmaceutical companies; safety evidence was rated very low certainty. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Antidepressants for pain management in adults with chronic pain: a network meta-analysis — Birkinshaw H, et al. (2023). Published in: Top-tier peer-reviewed journal. DOI: 10.1002/14651858.CD014682.pub2. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Meta-analysis of randomised trials. Funding: Independently funded. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is duloxetine (Cymbalta), cymbalta FDA approved?
Yes — FDA approved for Major depressive disorder (adults), Generalized anxiety disorder (adults and pediatric patients 7 years and older), Diabetic peripheral neuropathic pain (adults), Fibromyalgia (adults and pediatric patients 13 years and older), Chronic musculoskeletal pain (adults). Approval is for a specific indication, not for everything the drug is prescribed for.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.