Duloxetine – Effective Back Pain Relief
New FDA approval was granted in November, 2010 for once-a-day oral treatment of chronic pain in the bones, joints and muscles – including the lower back. F.D.A. panel-members appeared most impressed with the results of several double-blind, randomized clinical studies demonstrating effective low back pain relief.
Cymbalta – Not the Best Stand-Alone Treatment For Osteoarthritis
Duloxetine delayed-release capsules (Cymbalta) are one of several of a moderately-effective and newer class of antidepressants known as serotonin and norepinephrine reuptake inhibitors (SNRIs). Results showed the medication was less effective at treating osteoarthritis pain, but Cymbalta was “not inferior” to other available treatments. Use of 60 mg per day is the current maximum dose as the 120 mg per day dosing results were not strong enough to warrant approval.
Good For Fibromyalgia and Neuropathic Pain, Too
Previously approved by the United States F.D.A. for treatment of the conditions: major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, and fibromyalgia. In 4 double-blind, randomized clinical trials showing that duloxetine was significantly more effective than placebo for decreasing pain in patients with those conditions. The recommended dose is 60 mg daily.
Unpleasant Side-Effects May Occur
Gradually weaning off of prior anti-depressants and also gradually starting on duloxetine a good idea. These “Brain Chemicals” can have quite a potent effect, so gradual changes are typically safer, and better tolerated.
Adverse events or ‘side-effects’ that most people with musculoskeletal pain in the trials reported were nausea, dry mouth, insomnia, sleepiness, constipation, dizziness, and fatigue. (5% or more)
Uncommon events (less than 1%) include liver damage, allergic/hypersensitivity reactions, pneumonia, and suicidal tendencies.
Action Steps: If you have chronic pain – especially chronic back pain, this medication may be of help. Many can cut their use of narcotic pain meds by adding an anti-depressant like Cymbalta. Clinically, some doctors report that their patients with more neuropathic-type symptoms like paresthesias, burning pain, non-specific aches and fatigue respond best.
- Discuss transition to Cymbalta as part of your medication plan with your treatment team.
- Make gradual changes.
- Don’t forget the positive role and benefits of exercise.