. 2023 May 10;2023(5):CD014682. doi: 10.1002/14651858.CD014682.pub2

Summary of findings 2. Pain intensity summary of findings.

Estimates of effects, credible intervals, and certainty of the evidence for pain intensity in people with chronic pain
Bayesian network meta‐analysis summary of findings table
Patient or population: people with chronic pain Interventions: duloxetine low dose (< 60 mg), standard dose (60 mg), and high dose (> 60 mg); milnacipran standard dose (100 mg) and high dose (> 100 mg) Comparator (reference): placebo Outcome: change in pain intensity, as measured on multiple scales including 0‐10 VAS, 0‐100 VAS, Brief Pain Inventory, and the Short‐form McGill Pain Questionnaire Direction: lower is better (i.e. a greater reduction in pain intensity)
Total studies: 50 Total participants: 14,926	Relative effect	Anticipated absolute effect (event rate)			Certainty of the evidence (CINeMA)	Ranking* (2.5% to 97.5% credible interval)	Interpretation of findings**
Total studies: 50 Total participants: 14,926	Relative effect	With placebo	With intervention	Difference	Certainty of the evidence (CINeMA)	Ranking* (2.5% to 97.5% credible interval)	Interpretation of findings**
Duloxetine high dose RCTs: 14 Participants: 3683	‐	‐	‐	SMD −0.37 (−0.45 to −0.28)	Low^a,b	9 (8 to 13)	Small to moderate effect
Duloxetine standard dose RCTs: 18 Participants: 4959	‐	‐	‐	SMD −0.31 (−0.39 to −0.24)	Moderate^b	11 (10 to 15)	Small to moderate effect
Milnacipran high dose RCTs: 2 Participants: 1670	‐	‐	‐	SMD −0.22 (−0.40 to −0.05)	Low^a,c	14 (12 to 19)	Small effect
Milnacipran standard dose RCTs: 4 Participants: 1866	‐	‐	‐	SMD −0.22 (−0.39 to −0.06)	Moderate^a,b	14 (12 to 20)	Small effect
Duloxetine low dose RCTs: 6 Participants: 1104	‐	‐	‐	SMD −0.11 (−0.25 to 0.03)	Moderate^a,c	17 (12 to 21)	Not significantly different from placebo
Network meta‐analysis‐summary of findings table definitions Mean rank and credible intervals are presented. SMD interpretation based on clinical judgement and in line with Cohen 1988 and the Cochrane Handbook for Systematic Reviews of Interventions* (Schünemann 2022) as small (0.2), moderate (0.5) and large (0.8). CI: confidence interval; CINeMA: Confidence in Network Meta‐Analysis; RCT: randomised controlled trial; SMD: standardised mean difference; VAS: visual analogue scale The number of participants for each antidepressant reflects the total number of participants taking the antidepressant or placebo from the studies in the network meta‐analysis.
CINeMA grades of confidence in the evidence High: further research is unlikely to change our confidence in the estimate of effect. Moderate: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low: we are very uncertain about the estimate.

^aDowngraded due to within‐study bias. ^bDowngraded due to imprecision in the estimate. ^cDowngraded due to heterogeneity in the estimate. ^dDowngraded due to incoherence in the network. ^eDowngraded due to a small number of trials and participants; we cannot draw reliable conclusions.