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Spence's polemic on duloxetine loses power because most of what it is based on is wrong. 1 Making pronouncements in respected journals about good and bad medicine comes with the responsibility of knowing what you are talking about. Bad scholarship helps no one, especially those in pain; research in genetics, neurobiology, and psychology has contributed to huge advances in knowledge about the bio-psycho-social origins of pain.
Chronic pain is defined as pain of moderate or severe intensity that lasts for three months or more (think of a really bad headache lasting from Christmas to Easter). It affects one in five adults. Painful conditions are among the most prevalent conditions and are five of the top 11 in terms of years living with disability. Chronic pain destroys lives, has a huge negative impact on quality of life, is costly, reduces the ability to work or function inside the family, and may be associated with decreased life expectancy.
Here is a brief, non-comprehensive list of where Spence misses the point.
Women are not over-represented in trials. Chronic pain disproportionately affects women; their representation matches the epidemiology.
Pain is the most immediate of patient outcome measures,...