melatonin versus duloxetine for managing symptoms of osteoarthritis: a randomized controlled trial study

Background: osteoarthritis (oa) is a degenerative joint disorder causing pain and disability. the present treatments are inadequate to improve the underlying pathogenesis of oa. melatonin, because of its chondroprotective, anti-inflammatory, and antioxidant properties, may have a role in the management of oa. duloxetine is presumed to modulate pain through serotonergic and noradrenergic pathways. in the present study, as a first study, melatonin has been compared with duloxetine for its efficacy in reducing oa-related knee pain.methods: this randomized controlled trial (rct) study involved 60 knee oa patients treated at imam hossein hospital in tehran, iran. participants were randomly assigned to receive either melatonin, 3-10 mg per day, or duloxetine, 60-120 mg per day. the primary outcome measure was the 3-month change in the western ontario and mcmaster universities oa index (womac) score.results: compared to the duloxetine group, a reduction in the total womac score was noted in the melatonin group (p=0.001 and p=0.09, respectively). changes in womac pain score were significant in both groups (p=0.0001). additionally, the need for naproxen for breakthrough pain was significantly lower in the melatonin group (318.33±16 mg vs 810±35 mg with a p<0.001).conclusion: melatonin is more potent than duloxetine in pain reduction and functional improvement in patients with knee oa. considering the ability of melatonin to reduce the usage of nonsteroidal anti-inflammatory drugs, melatonin may be a safer agent for managing pain in oa.