COMPARISON OF DULOXETINE MONOTHERAPY VERSUS DULOXETINE AND GABAPENTIN COMBINATION THERAPY FOR NEUROPATHIC PAIN RELIEF

Background: Neuropathic pain is a complex and often refractory condition that significantly impairs quality of life. Pharmacological management remains the cornerstone of treatment, with duloxetine and gabapentin frequently prescribed. While both agents are effective as monotherapy, combination therapy may offer enhanced analgesic outcomes by targeting multiple pain pathways. Objective: To compare the effectiveness of duloxetine monotherapy with that of duloxetine and gabapentin combination therapy in relieving neuropathic pain. Methods: A randomized controlled trial was conducted over eight months at tertiary care hospitals in Lahore, Pakistan. A total of 120 adult patients diagnosed with neuropathic pain were randomly assigned to two groups: Group A received duloxetine 60 mg/day, while Group B received duloxetine 60 mg/day plus gabapentin 900 mg/day. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), and functional interference was measured with the Brief Pain Inventory–Short Form (BPI-SF) over 12 weeks. Adverse events were recorded, and statistical analysis was performed using SPSS v26.0, with significance set at p < 0.05. Results: By week 12, mean NPRS scores reduced from 7.6 to 4.7 in the duloxetine group and from 7.5 to 3.2 in the combination group (p < 0.001). BPI-SF domains showed significantly greater improvement in the combination group across all functional areas. Adverse events, primarily dizziness and somnolence, were slightly more common in the combination group but remained within acceptable tolerability limits. Conclusion: The combination of duloxetine and gabapentin demonstrated superior efficacy in reducing neuropathic pain and improving patient functioning compared to duloxetine monotherapy, with an acceptable safety profile, supporting its clinical use in resistant cases.