OBJECTIVES: Duloxetine is approved for the treatment of major depressive disorder (MDD) and general anxiety disorder (GAD), and for the management 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 pain medication use prior to duloxetine initiation among patients with each of these conditions. METHODS: US administrative claims were used to identify commercially-insured duloxetine initiators 1/1/2009-3/31/2010 who had any of the 6 medical conditions mentioned above during the 12 months prior to duloxetine initiation (defined as no duloxetine pill coverage in the previous 90 days). Utilization of pain medications including antidepressants, anticonvulsants, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants was assessed over the 3, 6 and 12 months prior to duloxetine initiation.  RESULTS: The study identified 19,546, 5,764, 2,334, 15,362, 12,317, and 27,781 duloxetine initiators in the MDD, GAD, DPNP, FM, OA, and low back pain (LBP) groups. Antidepressant use was high across all conditions over the 12 months prior to initiation, especially among patients with MDD (84.4%) or GAD (79.9%). Anticonvulsant utilization was highest in DPNP (63.1%) and FM (51.9%), lowest in GAD (39.5%), and similar among other groups (range: 42.8%-48.3%). Opioid use varied greatly across groups (54.5-81.6%), with the lowest use among GAD patients and the highest use among LBP patients. GAD patients had the lowest NSAID use (32.9%), while OA patients had the highest utilization (58.1%). The use of muscle relaxants ranged between 29.4% (DPNP) and 56.7% (LBP) at 12 months prior to duloxetine initiation. Pain medication use in the prior 3 and 6 months showed similar trends.  CONCLUSIONS: Patients used several types of pain medications prior to initiating duloxetine across disease states. The trends in use were consistent 3, 6, and 12 months prior to duloxetine initiation.