OBJECTIVES: Duloxetine is approved to treat major depressive disorder (MDD) and general anxiety disorder (GAD), and to manage the symptoms of diabetic peripheral neuropathic pain (DPNP), fibromyalgia (FM), and chronic musculoskeletal pain as studied in patients with osteoarthritis (OA) and chronic low back pain. This study assessed use of pain medications prior to duloxetine initiation among elderly patients with each of these conditions.  METHODS: Duloxetine initiators aged 65+ with Medicare Supplemental Insurance in 2007, 2008 and during January 1, 2009-March 31, 2010 who had any of the 6 medical conditions listed above during the 12 months prior to duloxetine initiation (defined as no duloxetine pill coverage in the previous 90 days) were identified via administrative claims. The use of pain related medications was assessed during the 6 and 12 months prior to duloxetine initiation.  RESULTS: The study identified 1682, 308, 1044, 1363, 4255, and 5189 in the MDD, GAD, DPNP, FM, OA, and low back pain (LBP) cohorts in 2009-2010. Antidepressant use during the 12 months prior to initiation was common, and was highest among MDD (87.2%) and GAD patients (83.4%). The use of anticonvulsants was comparable between cohorts, but highest among patients with DPNP (60.0%) and FM (54.7%), and between 47.0-52.4% among other cohorts. There was varied use of opioids across cohorts, ranging from 63.3% (GAD) to 84.7% (LBP). Non-steroidal anti-inflammatory drugs utilization varied with the lowest use among GAD patients (30.2%) and the highest among OA patients (45.8%). Utilization of muscle relaxants widely ranged from 22.0% (DPNP) to 40.4% (FM). Use of pain medication during the 6 months prior was similar, but was generally 10-15% lower. Use patterns in 2007 and 2008 were similar.  CONCLUSIONS: Across disease states, patients used a variety of medications prior to the initiation of duloxetine. Patterns of use have largely stayed the same from 2007 through 2010.