Comparison of Duloxetine with Lidocaine infusion in the management of fibromyalgia: A review

Abstract

Background: Fibromyalgia is a complex poly-symptomatic condition. These symptoms include chronic widespread musculoskeletal pain. No one treatment has been found to address all the symptoms of this syndrome. Pharmacological interventions which have provided improvement in the symptoms of the disease include duloxetine, lidocaine infusion and tramadol. The aim of this essay is to compare the analgesic efficacy and quality of life of fibromyalgia patients following the use of duloxetine or lidocaine in their management. Evidence derived from analysis of existing literature will be used to decide a preference for either of the two interventions. Methods: An electronic search of Medline, EMBASE, Nice evidence, Trip database, Cochrane Library and Science Citation Index from inception to April 2016 and update to July 2018 was done using the key words below. Google scholar search engine and manual search of relevant studies from bibliographies in literature was also employed. Quality of included Randomized control trials (RCTs) were assessed using the JADAD score (I - V). Most relevant studies were included in this review. These were independently retrieved by the two investigators and were discrepancy existed, resolved by consensus. Discussion: Evidence abound on the safety and efficacy of duloxetine in the management of fibromyalgia and it promises to be the ideal pharmaco-therapeutic agent for the treatment of fibromyalgia. However, some cases may be refractory to it, necessitating the use of other agents like lidocaine. There is a dearth of good quality randomized control trials in literature to support the safety and efficacy of lidocaine monotherapy in the management of fibromyalgia patients. Conclusion: This article explores evidence regarding use of duloxetine and lidocaine infusion in management of fibromyalgia. Although the potentials of lidocaine infusion in the treatment of this condition is acknowledged, clinical evidence from this review is insufficient to fairly compare the efficacy of duloxetine with lidocaine infusion in the management of patients with fibromyalgia.Well-designed RCTs are required to compare the qualities of these 2 interventions in management of fibromyalgia