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Duloxetine/Cymbalta for fibromyalgic pain….

Discussion in 'General ME/CFS Discussion' started by charles shepherd, Aug 27, 2015.

  1. charles shepherd

    charles shepherd Senior Member

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    Phase 3 trial of duloxetine/Cymbalta for fibromyalgic pain may show benefit for some patients with ME/CFS | 27 August 2015
    The results of a phase 3, Japanese trial of duloxetine/Cymbalta for pain in patients with Fibromyalgia have been published in the journal Arthritis Research and Therapy. Our medical adviser, DR CHARLES SHEPHERD, says that – while the results were not hugely significant – they may point to benefits for some people with ME/CFS.
    Duloxetine (trade name = Cymbalta) is a drug that is normally used to treat depression. It is sometimes used for a generalised anxiety disorder and for stress incontinence.

    It acts by normalising an imbalance in two brain chemical transmitters – noradrenaline and serotonin – that can occur in depression.

    continued on MEA website>>

    http://www.meassociation.org.uk/201...-for-some-patients-with-mecfs-27-august-2015/
     
  2. duncan

    duncan Senior Member

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    Oh, I fear this may be sending the wrong kind of message.
     
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  3. Snowdrop

    Snowdrop Rebel without a biscuit

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    Didn't do anything for me when I tried it. But I guess it might work for someone.
     
  4. charles shepherd

    charles shepherd Senior Member

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    It would be helpful if you could you explain why

    The intention is to inform people who have fibromyalgic type pain that there is some evidence from clinical trials to indicate that this is a drug that appears to be safe and effective for some people in this situation and that it is an option which could be discussed with their physician

    Patient evidence indicates that some people do find this drug beneficial. But at the same time there are others who have not had not gained any benefit and/or experienced adverse effects

    This situation is nothing unusual with a whole range of treatments for ME/CFS and FM
     
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  5. charles shepherd

    charles shepherd Senior Member

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    barbc56 likes this.
  6. charles shepherd

    charles shepherd Senior Member

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    This is one of the positive relies:

    I've been on this for 18 months and it has been very effective for nerve pain. I've also had no significant side effects. Consultant thought it might also help my sleep pattern but this is still erratic. I've had ME for 30 years and this has been the most successful for pain relief so far.
     
  7. duncan

    duncan Senior Member

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    What I come away with is that three out of the first four paragraphs tie into depression. I don't even want to read further, and I suspect neither will many other readers.

    At a time when many are struggling to disassociate the pathology of ME/CFS with psychological causes, this immediately - and repeatedly - thrusts a depression/ME/CFS connection in the face of the reader.
     
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  8. Jenny

    Jenny Senior Member

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    Dorset
  9. charles shepherd

    charles shepherd Senior Member

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    The new phase 3 clinical trial I referred to involves the use of this drug to treat pain and improve quality of life in fibromyalgia.

    As duloxetine is normally used to treat depression, I thought it would also be helpful to explain why a drug used to treat depression might also be helpful for treating musculosketal and/or neuropathic pain - which is clearly a major issue for many people with ME/CFS

    There is nothing new here - low dose amitriptyline, a sedating tricyclic antidepressant, has turned out to be an effective form of pain relief for some people with ME/CFS, and many other painful conditions.

    I also explained that duloxetine is used to treat painful diabetic neuropathy - nothing psychosocial in that diagnosis

    So I do think this is form of pain relief that is worth discussing
     
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  10. charles shepherd

    charles shepherd Senior Member

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  11. jimells

    jimells Senior Member

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    Cymbalta gave me a hypertensive crisis and an ice pick headache. The doctor insisted the medication could not do this, although it is in the literature. I decided to believe the literature and live.

    I'm glad some folks benefit from Cymbalta. With so many of us sensitive to medications, I hope folks will carefully consider the risks and stay alert to adverse effects.
     
  12. barbc56

    barbc56 Senior Member

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    ADs are often used for pain and aren't as addictive as opiates. I learned the hard way how much my AD was helping my pain. The company making the generic for Zoloft changed so the tablet looked different. Without realizing it, I was taking about half my usual dosage. Two months later I saw my neurologist as my pain had increased exponentially. He said we needed to raise the AD to a certain level which was my usual dosage! I felt so stupid.

    I do have depression as a comorbid condition which preceded this illness by almost twenty years and other than some tweeking of the AD have been asymptomatic. Once I was back on my regular dosage, the pain gradually returned to its usual level.

    I am now on Tramadol which works very effectively. It works in a similar way as an AD but not used for depression by itself. Strangely, opiates aren't as effective for my FM pain. Like other medications, I know others who do not get pain relief from Tramadol. It's important for your physician to know if you are on both tramadol and an AD to prevent serotonin syndrome

    Unfortunately. I can't take cymbalta as it gave me tachycardia, a dangerous spike in blood pressure well as extreme vertigo. However, I can't take any of the SSNRIs for the same reasons. But, I have no problems with the SSRIs.

    I know people who have been significantly helped by Cymbalta so it seems to be an individual thing and is definitely a good option to look into for pain control.

    Barb

    ETA Tramadol is considered a type of opiate but way down on the list so you don’t need to take a hard copy to the pharmacist like other opiates. You can also get a script that can be used for more than one month unlike the other opiates. This can be different depending on your state of residence. I live in Illinois and now for Oxycodone(?), you can only get one months supply and need a new script for more than that time.
     
    Last edited: Aug 27, 2015
  13. duncan

    duncan Senior Member

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    Maybe so, @barbc56 .

    Maybe this is a good drug for some of us.

    But I doubt this article is good for us.
     
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  14. Lynne B

    Lynne B Senior Member

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    Hi, all,

    I've been on Lyrica and duloxetin/Cymbalta for about 3 years for horribly painful toes, due to small fibre neuropathy. The toes (and hands) are usually worse during hot days or from contact with bedclothes at night. I think both help: it's nearly impossible to sleep at night without the Lyrica to cut the pain for instance. However, I'm far better off if I actually stay in airconditioning in the day and keep bedclothes away from my feet at night. So, if I can't control those two things then both these painkillers together help but certainly don't help enough. Maybe I should up the dose or have a look at Tramadol, as Barb mentions it works for her.

    However, I'm pinning my hopes for pain relief on Mirogabalin, the superior alternative to Lyrica now undergoing large-scale testing by Daiichi-Sankyo. Wasn't this discussed earlier in August on this sight?

    Cheers, Lynne
     
  15. barbc56

    barbc56 Senior Member

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    Too bad there isn't a campaign educating the public that ADs are also for pain.

    My daughter took ADs for migraines which really helped. She does not have depression.

    I get what you are saying and you have a point as unfortunately, the reality of depression linked with our illness is definitely there.

    I can only speak for myself, but I would not pass up a treatment just because it's an AD as I want relief.

    Though, not everyone here has pain.

    Barb
     
  16. Effi

    Effi Senior Member

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    I have the same reservations about this as @duncan. I don't currently have pain, I don't have fibromyalgia, and I don't have depression, but still a doctor thought I should take Cymbalta. When I asked why, as I don't have a pain problem, his answer was something along the lines of: 'Well, if you don't WANT to get better then don't take it.' As if it's some magical pill that will take away all your other symptoms too. And I've heard similar stories more than once from different patients.

    Don't get me wrong, if it helps people with neuro-pain, I'm all for it. It's just that it can provoke more confusion in an already very confusing diagnosis.
     
  17. charles shepherd

    charles shepherd Senior Member

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    I'm afraid that a significant proportion of my medical colleagues still think that ME/CFS is a form of atypical depression and should therefore be treated with antidepressants - even though there is no evidence from clinical trials involving drugs like fluoxetine (Prozac) to show that these drugs have any effect on the underlying disease process in ME/CFS.
     
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  18. duncan

    duncan Senior Member

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    Correct me if I am wrong @charles shepherd , but isn't this article suggesting doing the very thing you are wondering about on behalf of your colleagues - treating ME/CFS with antidepressants?

    Moreover, if the tie between ME and depression wasn't so frequently re-enforced, maybe your colleagues would stop feeling that way. You are welcome to double check my math, but it appears to me that in the body of the text ME/CFS is mentioned 8 times, a variation of depression/antidepressant 6 times.

    That's a statistical association that left this reader confused as to what you were promoting.
     
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  19. charles shepherd

    charles shepherd Senior Member

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    Duncan

    What I'm basically saying is that:

    1 There is no evidence to indicate that any antidpressant drug - including duloxetine - can treat the underlying disease process in ME/CFS

    2 However, there is SOME evidence to indicate that SOME types of antidepressant medication - including low dose amitriptyline and duloxetine - can be helpful, sometimes very helpful, in relieving musculoskeletal and neuropathic pain in a number of MEDICAL conditions, including diabetic neuropathy and ME/CFS

    Which is why I felt this paper was worth flagging up and discussing here on PR and why this is a drug treatment option that MAY be worth discussing with a doctor if someone with ME/CFS has fibromyalgic and/or neuropathic pain and no other drug treatment has been successful

    So I still think this is a helpful discussion to have - even though you clearly disagree!
     
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  20. duncan

    duncan Senior Member

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    A discussion is a two-way street. This is a discussion. Yes, I agree, this discussion may prove helpful to some.

    The article is not a discussion.

    Hey, look, this is your article. As a reader, I came away with a different message than the one you claim to be trying to make. I am just one point of feedback. You can take or leave my concerns.
     

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