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"Cymbalta Can Help" - Can it?

XCSwimmer90XXCSwimmer90 Posts: 20
edited 06/11/2012 - 9:01 AM in Chronic Pain
The last time I saw my PM/Physiatrist she talked to me about Cymbalta for my back pain. I turned it down for a number of reasons.
1) I'm concerned about the side effects/systemic effects
2) If it doesn't work I'm concerned about the WD symptoms (read some horror stories)
3) The stigma associated with it
4) Most importantly, I just don't believe that it could help. I know it's an ignorant thought, but I'm just being honest. I'm a pharmD student with a great interest in psychopharm. I understand the biological and psychological mechanisms of pain how how an antidepressant might work to relieve pain. I just intuitively feel like it would't work. On a parallel, I've never thought my pain to be associated with my stress/mood, and I have thought about it a lot, as objectively as possible.

[Instead I took a prescription of Zanaflex (muscle relaxant). I tried it for a couple weeks, at different dosages, and not once did I feel a muscle relaxing effect. I didn't really even feel any side effects until I tried 6mg and passed out for an hour]

So I guess my question is, has anyone had an success using Cymbalta for back pain. I've read some information criticizing the trials and retrospective studies using the research from Eli Lilly clinical trials that claimed no association between Cymbalta and pain relief. Cymbalta's indication for pain relief also just squeaked by in FDA approval voting.

I know there are a lot of people on the boards saying "it doesn't work". I feel people are more likely to say it doesn't work than it does. So, Anyone have any luck?

I appreciate your responses!


  • It sounds like you have pretty much talked yourself out of using this medication....

    One of the biggest things people need to know as I wrote in another post...is that anything online is going to have a more negative slant than positive. This is true for anything from medicine to a business or service.

    People are 10 times more likely to write about a negative experience than they will to write about how great something is.

    And obviously with a chronic pain board...we are going to hear all about surgeries that haven't worked, or medicine that may have not helped. There are thousands and thousands of people who had surgeries that are perfectly fine and out living their life...

    That is why I actually never put much stock into others feelings about a certain medication. We are all different from our actual illness to metabolic makeup to other health issues, to interactions with other medicines we take..etc. As in the variables are too many to list.

    So if someone says.."ohh..this didn't work for me"....That has absolutely nothing to do with how it will work for myself.

    I used Cymbalta for 3 years and it worked wonderfully for my nerve pain. I also followed the Dr.s instructions, just like weaning off of most medications...and we tirated down slowly to not have any negative withdrawals....

    I always give any new medication a month to see if it works well, as well as get through any side effects that happen to come more in the beginning. Obviously if someone has an actual allergic reaction that requires emergency treatment...then they would stop immediately.

    But most every time I have started a new one...it takes a bit to work the kinks out.

    I also happen to think that the mind is extremely powerful...That is why placebos are so effective. Just like with any treatment or surgery....I happen to strongly believe in having a positive attitude to help.

    Obviously your choice....but it sounds like you don't believe it will work for you...

    I wish you luck either way...
  • Thanks for your response.

    I absolutely agree with the power of the mind. If you think about it, everything we experience and feel is created by the mind. I know I've talked myself out of taking it. I have read a ton of negative things about. Now I think I'm trying to convince myself that it could work because I don't have a lot of options left medicine wise.

    I let myself fall out of shape. I used to weigh 20lbs more just because of muscle mass. Supposedly if I'm in better shape, I'll feel better (which isn't really true because I have been in very shape and felt the same way). So now I'm stuck in a paradox. I'm so I'm supposed to get in better shape to feel less pain, but working out kills my back. That's where I'm hoping medicine will help.

    It would be convenient if it did work. I'm really looking for something that manages the pain but doesn't knock me out. I've tried just about every NSAID in the book (OTC's + nabumetone, naproxen, meloxicam), nortriptyline, lidoderm patches, cyclobenzaprine, Zanaflex, and Lyrica... I feel like I'm forgetting some others.

    Again, I'm just trying to get hope that maybe it will work.
  • I posted a long post yesterday on another thread about this med. Since you have the knowledge you have I won't repost all of it here.

    This specific med as you know effects several neurotransmitters that DO cross the brain barrier unlike most that don't cross it.

    This med does not help pain levels like a pain drug or muscle relaxer or any other med in that area of treatment. It also does not help as it helps with stress, depression etc.

    This is as close to verbatim as I can remember that my Dr told me "It does not truly remove your pain, it effects your brain chemicals to trick you into thinking you no longer have pain".

    I am not on it myself nor do I know if I would take it for pain or any other reason. I have considered it though as from a "chemical" view point I can understand how it could help.

    Hope with what you already know from your education that this makes sense to you :)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • yes i take cymbalta
    yes it works for me
  • It was life saver for sciatica. Dr. said it can allow nerves to relax which in turn allows them to heal faster. Did not do much for depression though when took it years later for that reason. Side effects were that I always felt tired, very tired. I was in school and could not keep it up with school. But thats not to say it will not work for you. You know that no two people are alike so one med may affect me totally different than you.
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • MsHumptyDumpty said:
    This is as close to verbatim as I can remember that my Dr told me "It does not truly remove your pain, it effects your brain chemicals to trick you into thinking you no longer have pain".
    This is exactly what I don't like to hear about certain Rx's. Perhaps I'm a control freak, but I don't like to think of anyone or anything 'tricking' my brain into thinking anything differently than I might otherwise feel-even if those tricks might sound positive on review. I like to think that I'm in control of my brain..even if it's all an illusion.

  • Robin said:
    MsHumptyDumpty said:
    This is as close to verbatim as I can remember that my Dr told me "It does not truly remove your pain, it effects your brain chemicals to trick you into thinking you no longer have pain".

    This is exactly what I don't like to hear about certain Rx's. Perhaps I'm a control freak, but I don't like to think of anyone or anything 'tricking' my brain into thinking anything differently than I might otherwise feel-even if those tricks might sound positive on review. I like to think that I'm in control of my brain..even if it's all an illusion.

    to the best of my knowledge cymbalta blocks pain receptors in the spine at the synaptic junctions, it doesn't trick a person into thinking they have no pain.

    also, you say that cymbalta effects several neurotransmitters that DO cross the brain barrier unlike most that don't cross it.

    it is my understanding that neurotransmitters, particularly the monoamine class that include such major NT as dopamine and serotonin, don't need to be supplied from outside the brain; they are synthesized from within the brain and therefore do not cross the BBB. i don't understand what you are saying here. there are more than 100 neurotransmitters in the brain, what class of NTs are you referring to? what do you mean when you say "most that don't cross it?" what is "most referring to?

    some may consider my response pompous, but i thought we weren't to talk about things we were not schooled in. just an observation ... an opinion ... nothing else. take from it whatever you will or won't. it is immaterial to me. just as you have posted your opinion so too have i.
  • One thing I have learned in the years of taking meds for pain is that everyone's body's is different in how it responds to them. One persons miracle med can be anothers nightmare med. A large sample size in a drug study is meant to account for this variation, but if you fall into the percent of non effective, or negative effect, obviously its a bad medication for you. As you brought up just because the FDA approves a med for a certain condition doesnt mean that every clinical trial was set up the same or what margin of success it passed by.

    I've been taking cymbalta for five months now. When I started taking it I also got a very successful si joint injection, so I dont know how much, or even if cymbalta is helping. I probably should wean myself off it to see if it is really helping, but because I was in so much pain in the past I'm too scared to even go there. This trial an error process of testing medications can be exhausting and even expensive, but it is a part of the striving to cope with chronic pain. Good luck to you if you do give it a try...Mitch

  • I'm not sure what the neurotransmitter (NT) discussion is here. I think someone deleted something so I'm having difficulty following this. Basically neurotransmitters are produced by the neurons, whether that is in your brain or in the nerves of your finger. You also have NT receptors all over your body. Why do people on opiates suffer from constipations? Because there are opiate receptors in the GI tract. When activated they increase water absorption in the large intestines leading to constipation.

    Antidepressants (at least Tricyclics, but probably SNRI's) work on the ascending and descending pain pathways. You have to remember that pain is not just a one way street. As pain signals are sent from the site of pain, messages from the brain are also sent back from the brain. A simple example of this is people with chronic back pain may have muscle tightness because the brain is receiving the pain signals, therefore sending protective muscle tightening signals back.

    Within your midbrain there is area called the periaqueductal gray (PAG). A simple definition without going too much into detail is that it processes pain signals. When serotonin binds in receptors in this area, it begins a reaction that activates natural opiates to stimulate opiod receptors from the incoming pain neurons. This inhibits the pain signals and causes analgesia. You wouldn't feel "high" off of antidepressants because this is only causing a localized effect. Taking oxycodone creates a systemic effect where the entire blood supply has the drug and any part of the brain can receive it. Immodium (anti-diarrheal) is also an opiate, but it doesn't pass the blood brain barrier, so you don't get high off of it.

    So by increasing serotonin in the brain, one would hope to be able to activate the system I described above. Cymbalta is an SNRI- Serotonin-Norepinephrine Reputake Inhibitor. I'm still trying to figure out of NE works into this. I'm not sure anyone is really sure how it works. It's known that SSRI's aren't effective in fighting pain. That said, you have to remember though that SSRI's aren't really that "selective" and unwontedly inhibit a lot of neurotransmitters leading to side effects. SNRI's have a broader range of neurotransmitter coverage inhibition. TCA's have an even broader range. You have to remember that activation of one thing can (or can not) mean inhibition of another. The drugs are also inhibiting all sorts of other, seemingly unrelated things that make actually have a cascading effect. The brain is so complex it's hard to really comprehend how it works.

    So when the doctor says the antidepressants change your "perception" of pain, it's true. But that's exactly what an opiate is doing. Opiates bind to opiod receptors which inhibits substance P (the NT responsible for pain), amongst other things. Or Anything that involves the nervous system directly is affecting your perception of pain. It's a strange and scary thought to know that all of our emotions and feelings are just chemicals (though that doesn't mean our emotions and feelings don't mean anything).

  • I have not taken cymbalta, nor have I taken lyrica. I'm worried about addictive effect of any drug. As a matter of fact, I turned down percoset and valium when I ended up in the ER after rupturing my disc. The medical staff tried not to laugh...they said I would need them, they were right.

    But I've been cautious with my use of any drugs and recently just pulled myself off Tylenol/Advil b/c I thought my body built a tolerance. Now, I only take OTC when I am having a 'really' bad day.

    So yes, the mind is powerful. I've had to really pay attention (or not) to my pain so I only notice when it is really bad.

    That being said, I decided to try trigger point injections (Dry needling) into my facial muscles to try to help relieve some of my lower back pain that the Physiatrist & PT folks believe are partially caused by 2 years of protecting my back. Do I believe in them? Not sure. Seems like a form of accupuncture but the side-effects seemed low so gave them a shot and 3-days out, not sure. I guess you have to decide if it's worth trying it for a month (4-6weeks) and go from there.

    GOod luck.
  • I've been on Cymbalta for a couple of months now, and I can't say that I've noticed a lot of improvement in pain other than in my hands and knees. It has definitely NOT helped with my back pain, which is really unfortunate.

    I've been on a couple of drugs that have terrible withdrawal symptoms if you don't titrate down properly, so I'm fully aware that it will be a slow process when we make the decision to stop this medication.

    It took a while before I was willing to add another 'thing' to my daily collection of prescriptions, but I figured it was worth trying the Cymbalta. The only side effect that may have shown up for me is that I was having some hot flashes, which may have been related or may have been as a result of starting Humira, as well.

    I'm quite a bit older than you, Swimmer, so I've made a decision that I want "quality" over "quantity" of life, so it is definitely a bit easier for me to make a decision on all these things! :-)

    Good luck - hope you find some relief, and hope you are trying all the non-prescription treatments out there that might give you a bit of a reprieve.


  • Robin said:
    MsHumptyDumpty said:
    This is as close to verbatim as I can remember that my Dr told me "It does not truly remove your pain, it effects your brain chemicals to trick you into thinking you no longer have pain".

    This is exactly what I don't like to hear about certain Rx's. Perhaps I'm a control freak, but I don't like to think of anyone or anything 'tricking' my brain into thinking anything differently than I might otherwise feel-even if those tricks might sound positive on review. I like to think that I'm in control of my brain..even if it's all an illusion.

    This is what most every medicine that is for pain....from the nerve pain meds, and especially any narcotics....they are obviously not "curing" anything....they are meant to go to receptors in your brain and make it so you don't care as much...

    As in...you have a broken leg...take some Percocet to help....it is not fixing the broken leg....it is dulling the pain...

    The nerve pain meds...like Cymbalta...are meant to help target the nerve pain...Just like a muscle relaxer....relaxes the entire body to help with that type of pain...

    The key in treating chronic pain is to first off know that any medicine you take is not meant to make you pain free...If it is...than most likely it's too much medication. Secondly...the most effective way to treat cp is by a combination of treatments...from different medicines that include opiates/muscle relaxers/nerve pain meds/depression meds/sleep meds, surgery if needed, injections, massage, exercising, Physical Therapy, TENS unit, acupuncture, Cognitive Behavioral Therapy, seeing a counselor, aqua therapy, stretching/yoga,no smoking, eating healthy, maintaining a healthy weight......just to name a few! LOL

    And even doing all of these things...most Dr.s that treat cp feel that a 5 on the pain scale is a good place to shoot for..I am a 5-7 daily depending on the day/activity....I could up my dosage of pain meds per my Dr.s thoughts...but I choose to try and keep my tolerance level as high as possible as I will most likely live with pain the rest of my life. I haven't upped my dosages in over 2 and a half years...

    It's certainly your choice to not take anything....but for many of us, pain medicines are just one part of our way to lessen our pain.

  • XC - Thank you! You explained neurotransmitters and such MUCH better then I was able to do :)

    I don't know who or what posts was edited. I didn't. I did have a longer post about this in a different thread.

    babyruth - I posted my knowledge of this med - of course each person is to then make sure that what has been shared with them are facts.
    There are some meds that do cross (not enter but cross) the brain barrier however most don't. If you want to know how I would point you to XC who has done a wonderful job explaining nuros.
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Cymbalta for depression and for the nerve tingles in my leg post-surgery. It was a great drug for my depression and I can't say that I really noticed much improvement in my leg pain, BUT . . . I switched to Prozac from Cymbalta on retirement, as I have crap prescription coverage in retirement, and Cymbalta is, as you all know, very expensive. I just had a doctor's appointment this morning and told him that I didn't care how much it cost, I want to go back to it. Not only is my depression worse since switching, the neuropathy and radiculopathy in my legs is worse. I'll let you know if about a month if I feel better.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Thanks lsteller.

    Crossing the blood brain barrier depends on two factors mainly. 1. molecule size. of drug. Only very small molecules can fit through the BBB. 2. solubility. molecules must be lipophilic in order to work through the membrane.

    I would imagine cymbalta must cross the blood brain barrier. As a antidepressant it is a central nervous system agent. For it's effect on depression it must work on the brain's neurons.
  • Cymbalta is an anti-depressant but it works on your nerves and low back pain. I took it for 3 years and just recently weaned off of it and had no awful side effects as I came off of it slowly because I started taking another anti-depressant for different reasons and because my leg sciatica has calmed down a bit.

    I have read online that the FDA has approved it for treating musculoskeletal pain from Osteoporosis and chronic low back pain.

    I was thinking about restarting it again because my leg pain seems to flare up the more active I get. I found it helpful for me. I did have some minor drowsiness when I first started taking it but got used to the side effects. I hope it helps your pain. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Cymbalta was a Godsend for me. However I experienced what only about 6% of patients experienced. Chronic diahrea. Spoke with drug mnf, they said I would not be able to take it. Imodeum or anything would not help.
  • I have some very serious back issues, don't we all??

    I have tried so many different drugs, surgeries, you name it, in looking for a cure for this ever prevalent back pain. Cymbalta helps, Lyrica did not. As everyone has said, we are so different in how drugs impact us, and what works today may not tomorrow. Cymbalta is all I take now.

    Other than an occasional Advil.. which I try to avoid unless the pain is very bad.

    I became resistant to Tramadol a few years ago and wanted to get off of it anyway. I do a variety of things to cope with my back pain.. guided imagery, walking mediation, art therapy, mediation, stress control, pilates, chiropractic, and massage, and a anti inflammatory diet.. all tailored to me and works for my body. It is trial and error, seeing what is enough and what is too little.

    Next for me may be regenerative medicine. I am exploring all my options. I sure don't want another surgery unless I have to wear Depends every day. I already look like Edward Scissorhands!!

    Best to you,

  • NO! It does not reduce relieve my pain level. Come on. .please, this is another claim by this drug company to say it does more than it really does. Chronic pain of years is just and receptor numbing or rerouted neuron signals is not what this drug can lay claim to.
  • Cymbalta definitely reduces my arm and shoulder pain. People are all different in how they respond to particular medications
  • I do take Cymbalta. 120mg in the morning. I take it for depression, not pain, but I have noticed when I run out of Cymbalta my back hurts more than usual. I don't have any side-effects. The withdrawal is unpleasant, true, but you will have ample time to decide whether or not the med works for you before you become physically dependent on it.
  • I took Cymbalta for over 2 years. I was in a low place & pretty desperate when I first started taking it. I remember to begin with saying "It does nothing for my pain but it's really improved my mind so I'll keep taking it". To be honest I always considered my mind to be very strong. I recognized I was very depressed but I had a very good reason to be! Take away my chronic pain & I won't have anything to be depressed about. I wouldn't of taken an antidepressant, probably needed one so Cymbalta was a good compromise for me. It never reduced my pain.

    When I decided I wanted to reduce my meds & find out what was helping & what wasn't Cymbalta was one of the last I stopped because I was scared to come off of it. Even doctors over those 2 years had seemed reluctant even saying things like "Stopping can fry your brain!". My doctor gave me a very slow tapering plan & it was very EASY to stop. I had no problems at all.
    When I stopped taking it I felt like someone had turned the lights on! I hadn't realized how it had dulled me. I was really surprised. I didn't think it was having any negative effect. I was worried that maybe it had be masking depression & that would return but the truth was Cymbalta was making me a little bit depressed, just less alive, a bit fatigued. I felt so much better once it was out of my system. Maybe it helped me get past a dark time but I wish I hadn't stayed on it for so long. My pain levels didn't change with or without it.
    Osteoarthritis & DDD.
  • I was prescribed Cymbalta for a combination of chronic pain from osteoarthritis and major depressive disorder with melancholia. I started with 30mg for the first two weeks, but had to stop taking my daily 1200 to 1800mg of ibuprofen and also quit drinking. For depression , it was amazing. I felt relief from my despondency within a handful of days, and that has continued through this, my third month. I had my dose increased to 60mg to try and get relief from the chronic pain, but it has not been effective for me in addressing that - thus my rating. For depression, I give it a 10, but for pain (my experience) I have to give it at best, a 3. After consulting with my doctor, he said I could resume taking ibuprofen at a much lower dose.
  • My rheumatologist gave me info on cymbalta last month. I threw it away. No way was I going on anti-depressant because it might help with my pain. Then my PCP told me she wanted me to try it. 13 yrs of pain that only 40mgs of prednisone helps. Then two days on cymbalta and my pain is so much less. I can walk without a limp, I can move my hands and walk on my feet without wanting to cry. I have a laundry list of problems, most of which are auto-immune. My hope is that this can help with my pain for a while until maybe cimzia or another biologic can help with joint destruction. No matter what right now it's a miracle drug for me. I just wish I hadn't been so judgmental about it.
  • pbefumoppbefumo Posts: 1
    edited 12/19/2014 - 2:35 AM
    First, I should mention I have chronic pain. I have severe DDD, osteoarthritis, gout, rheumatoid arthritis, and fibromyalgia. I'm only 60 years old, and yes, I'm a mess.

    As you can imagine I take a number of different pain meds, and unless you're taking NSAIDS (which actually reduce inflammation) ALL pain medication works by convincing your brain you're not in pain. Vicodin doesn't make the pain go away, it simply makes you care less about the pain.
  • French1eFFrench1e La Vergne, TNPosts: 2
    I just started Cymbalta 30mg last night.  I've had two discectomies - lumbar and cervical.  I'm also on Oxycodone 15mg x 4/day, Oxycontin 60mg x 2/day, Lyrica 200mg x 3/day, Baclofen 10mg x3/day.  Until I added Cymbalta yesterday, I was stuck in bed all day and night in pain with major depression and wishing for someone to put me out of my misery.  Cymbalta helped me sleep through the night, wake at 7:30am on my own - no alarm - and started cleaning and cooking and I can't believe the turn around in such a short amount of time!! I'm so grateful!  I feel like no only did it help my pain in a major way, it's driving me to get up and get stuff done!  I love it!  I did have nausea last night but I struggled with nausea while I was in pain before.  I also have essential tremor and this afternoon my tremors really kicked in, more so than before Cymbalta, but I'm good with the side effects because I love the pain relief and the get-up-go!!!  Just wanted to share that with anyone considering adding Cymbalta to their treatment plan.
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