Intended for healthcare professionals

Letters Bad medicine: the rise of duloxetine

Author’s reply to Moore and colleagues

BMJ 2014; 348 doi: (Published 19 February 2014) Cite this as: BMJ 2014;348:g1515
  1. Des Spence, general practitioner1
  1. 1Glasgow G20 9DR, UK
  1. Destwo{at}

Pain is indeed an important issue. But the current definition—“pain is what the patient says it is”—is far too loose.1 2 3 The reported incidence of pain varies 10-fold by country,4 so this definition is simply biologically implausible. Pain is cultural, not merely medical, and it is the major medically unexplained symptom. To suggest that one …

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