American Board of Family Medicine (ABFM) Practice Exam 2025 - Free ABFM Practice Questions and Study Guide

Duloxetine is primarily indicated for patients with simultaneous chronic pain conditions because it is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has been shown to be effective in treating both depression and chronic pain syndromes, such as fibromyalgia and diabetic neuropathy. The dual action of duloxetine on both the serotonin and norepinephrine pathways not only addresses the symptoms of depression but also modifies pain pathways, providing a broader therapeutic effect for individuals who suffer from these coexisting conditions.

In contrast, while nortriptyline can be beneficial for chronic pain, especially neuropathic pain, it is primarily indicated for depression and does not have the same breadth of evidence supporting its use in conjunction with chronic pain conditions as does duloxetine. Citalopram and fluoxetine, both selective serotonin reuptake inhibitors (SSRIs), are primarily used to treat depression and anxiety disorders and do not have strong indications for pain management. Therefore, duloxetine stands out as the most suitable choice for patients dealing with both chronic pain and depression.