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Old 06-23-2008, 06:40 AM   #1
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DULOXETINE for neuropathic pain

Hi all

Has anyone been prescribed duloxetine for neuropathic pain? I have recently been diagnosed with a condition called CENTRAL SENSITIZATION SYNDROME its very much like crps/rsd. Its used alot for neuropathic pain in diabetes, shingles, but i'm the first of 2 of us to be prescribed it at my hospital by my pain management specialist/consultant. Anyone who has used it i would appreciate any feed back.

thanx tkb

 
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Old 06-24-2008, 06:59 AM   #2
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Re: DULOXETINE for neuropathic pain

this is cymbalta,right? it can help with certain types of pain that is not the normal type. i tried this for my central pain and my RSD pain but had an INCREASE with my central on it for some insane reason. but everyone does respond in their very individual ways when it comes to every med we take. something that worked badly for one person may work well for others. you just really have to try any med yourself to really see how it will work for you and your pain processes.

i am curious as to how you actually aquired the central if you don't mind me asking since it has to do more with spinal cord damage in most cases or some affectation of the spinothalamic tract within the cord itself,or the thalamus in the brain being damaged or affected. did they ever actually call this central PAIN syndrome? exactly what does your pain feel like and how large of an area do you have affected?

i woke up after my spinal cord surgery,right from under anesthesia and my central was just 'there' waiting for me burning and stinging like hell on both shoulder blades and a large patch on my inner left arm(thought it was "just" post op pain but it never went away). i have tried many different things to help relieve what just feels 24/7 like a second degree burn that just never heals, for almost five years now. the absolute best thing i have really found is the lidoderm patches(no side effects either). they were actually invented to try and treat shingles pain. they work well when this crap just flares like all get out. otherwise i don;t normally keep it covered since it will create even more hypersensitivity. i have actually had my shoulder blades go down from the screaming ten it was when i woke up to it,down to about maybe a 2? somehow the blade area just appeared to desensitize itself over time. that was huge. but the arm crap is still there burning and stinging its way thru my day.

do you actually have some sort of c spine issues or other spinal issues that caused this? it just sounds like we are both dealing with the very same thing just a different variation on the name given it? if not,do you know what triggered this in you?

have you tried lyrica yet? this med worked actually on both my central and my RSD that i have in my right knee but my side effects were just way too over the top to even try and stay on it. but i do know of others who have had no side effects, unfortunetly,its all trial and error. but lyrica DID help,so if you have not tried that one yet,you could try that too,depending on how things go with cymbalta. this is just one of those types of syndromes that really require a good PM and alot of trying to see what might work for you. sorry you ended up with this crap too. good luck with this,and let me know how things go with the cymbalta. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
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Old 06-29-2008, 02:07 PM   #3
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Re: DULOXETINE for neuropathic pain

Hi marcia

thanks for your resonse. Yeah i had cervical discectomy c5/c6 in 2005. I've been seeing a pm consultant and specialist since jan 07, had cervical epi, lumbar epi and nerve block in feb this year. Been on Lyrica since Jan 07, i was recently up to 550mg per day but it gives horrendous side effects, swellings etc. I've been on amitriptyline, now taking nortriptyline 50mg at night, diazepam 5mg x 2 per day, the lyrica helps a bit but its finding the right balance for me. 300mg per day less side effects but not enough response for pain. Nortrip helps me sleep, amitrip knocks me for six and when you've got a young family to contend with it aint easy. Been on the duloxetine for 3 weeks now 60mg per day, i hasnt done anything for me as yet but i feel sleepy, dopey and get odd dizzy spells. I've also got disc degeneration going on in my spine and large herniation in lumbar spine, healthy arnt i ! I'm 38 going on 98. So yes i have issues going on with my spine, surgery etc, its real crap this condition, nagging, draining, you name it is does it, i flare up all over, numbness in limbs, swellings, odd sensations, and not least the pain. I dont really know what else to say, if you look at my history i've been on this forum for about 12 months. I'm sorry you have this god awful condition also, its not well known over here, still in its infancy of being recognised by many dr's, my pm team are great though so thats a good thing but it doesnt solve the problems you have to live with day in day out.

good luck to you and thanks again for your response, its very much appreciated. tkb

 
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Old 06-30-2008, 08:15 PM   #4
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Re: DULOXETINE for neuropathic pain

marcia:
Welcome to the boards although you have been here for awhile. I know that nerve pain is one of the worst pains to deal with. It is very hard to control, very difficult to find the right drug or combination of medications/therapies that will help some. I do want to be honest and tell you that you probably will never be 100% pain free and that is not the goal of PM(pain management). I am sure that your doctor has probably already told you this. The other thing is that you have to take the amount of side effects of each med compared to how much pain relief it does give you. It is a big balance for most of us here especially with nerve pain. I know that it is for me. I have chronic nerve pain in my feet and have been dealing with this pain for over 5 years now. I have been through a HUGE assortment of medications, injections, epidurals, and surgeries to try to help. I may be at the point of the pain not getting any better since any increase in my meds results in intolerabe side effects.

I do know that duloxetine is the generic name for CYMBALTA in the United States although it is not available as a generic yet here. I will give you a list of possible medications that can POSSIBLY be successful in treating nerve pain. The HUGE problem is that each one of us is different in our pain response and trying to find that delicate balance is sometimes a pain staking process in itself. Another thing to be careful of concerning ANY medication that is also an anti-depressant or has anti-depressant qualities is to NEVER EVER stop taking them cold turkey. It is always best to gradually stop taking them and I can tell you from experience that duloxetine was one of the more difficult medications for me to stop taking. Anyway here is the list of meds that can help(the capital letter words are the brand name in the United States and the lower case word beside it is the generic name of the medications)

Anticonvulsants - Lyrica(pregabilin), Neurontin(gabapentin), Lamictal(lamotrigine), Trileptal(oxcarbazepine), Tegretol(carbamazepine),Topamax(topirama te), Klonopin(clonazepam) (even though it's technically a benzodiazepine)

Tricyclic Antidepressants - Elavil(amitryptiline), Pamelor(nortriptyline), Nopramin(desipramine), Tofranil(imipramine), Sinequan(doxepin), Surmontil(trimipramine), Anafranil(clomipramine)

**very good at treating nerve pain & helpful with sleep so usually prescribed at night**

SNRI Antidepressants - Cymbalta(duloxetine), Effexor(venlafaxine), Wellbutrin(bupropion)

**very effective for nerve pain & also depression that usually accompanies chronic pain, many people on these boards have success with Cymbalta**

Atypical Antidepressants- Desyrel(trazodone), Ultram(tramadol),
Ultracet, Ultram ER

**good at treating nerve pain, tramadol also has a mild opiod quality to it so IT IS A MILD NARCOTIC**

SSRI Antideprests- Lexapro(escitalopram oxalate), Paxil(paroxetine), Prozac(fluoxetine), Zoloft(sertraline), Celexa(citalopram), Luvox(fluvoxamine maleate)

Opiod/Opiates- hydrocodone(Vicodin, Lortab, Norco), oxycodone(Percocet, Oxycontin, Oxy IR), hydromorphone(Dilaudid), oxymorphone(Opana), methadone(Dolophine), fentanyl(Duragesic patch, Actiq), morphine(MS Contin, Avinza, Kadian)

**can be useful for certain types of pain especially when used in combination with other non-narcotic meds**

I can tell you that my current list of medications are:
fentanyl patch 50mcg/hr
Lyrica 600mg/day
Trileptal 1500mg/day
Percocet 5/325mg up to 6/day
Lexapro 10mg/day

I hope this information helps you out.

brian

Last edited by brianpain33; 06-30-2008 at 08:18 PM.

 
Old 07-08-2008, 04:30 AM   #5
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Re: DULOXETINE for neuropathic pain

blimey you know your stuff! After nearly 5 years of suffering i thought i knew my stuff. Like many others i react badly to certain meds and i know its trial and error, i'm on my 5th week of duloxetine 60mg per day and it aint touched me, still on 300mg lyrica, any higher for me and i react bad been up to 600mg in past, nortriptyline 50mg at night. I've got mental health issues going on at the moment, what i've been through and going through has put me into low mood, anxiety and panic attacks so awaiting referral to see mental health team, also family therapy and ocupational health therapy. The list is never ending and i'm in a whirl with it all. I slipped through the net here in old blitey on the NHS system! i should have been seeing the pm team after my surgery in 05 for C5/C6 prolapse acd, but i didnt, basically left to get on with it, pm late, but hopefully not too late! The pain in just awful, good and bad moments not good and bad days and so unpredictable when it flares up. I don't know if you've heard of central sensitization syndrome which they've diagnosed me with with mechanisms of crps but its absolutely horrendous. I'm obviously not as mobile as i was some years ago and deteriorating mentally and physically although its not life threatening its life changing which for me has had a massive psychological impact, i've had adaptations done to my home and getting a mobility car soon possibly with adaptations. Thanks again for your info i hope all goes well for you in the future and i know what your going through like many others, we've all got to hang in there

regards trace

 
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