Chronic Pain Today

Cymbalta, or the drug duloxetine hydrochloride, has been cleared by the FDA as only the second drug for fibromyalgia. However, not everyone can take it. There are some side effects of Cymbalta and there are various dosages for different conditions.



Nursing mothers should not take Cymbalta because the effect on the infant is yet to be known. This also goes for pregnant women during the 3rd trimester. There is potential risks to the fetus can include extended hospital stays, tube feeding, and some respiratory distress.



Those with renal failure or impairment should not take Cymbalta.


The elderly should not take Cymbalta as there is no dose adjustment for it. If it is prescribed, special care should be taken and the patient needs additional onitoring.


Those with Hepatic insufficiency should not take Cymbalta.


Cymbalta is designed for those with fibromyalgia, diabetic neuropathy, Generalized anxiety disorder, and and major depressive disorder. The dosing ranges from 20mg to 60mg once or twice a day. For more info on dosing Cymbalta see the various dosages for different conditions.

Cymbalta, brand name of the drug duloxetine hydrochloride, has now been accepted as the second drug available to help in the treatment of fibromyalgia. This medicine is available in three strengths: 20mg, 30mg, and 60mg. Depending on what the Cymbalta is treating there are different starting doses.

Fibro

Starting dosage of Cymbalta for fibromyalgia is 30mg once a day for one week, and then a maintainence dose of 60mg once a day.

Diabetic Peripheral Neuropathic Pain

Cymbalta for Diabetic peripheral neuropathic pain has a dosage of 60mg a day, with a slower starting dosage for those that are already in renal failure.Studies haven’t shown how effective this drug is in this condition past the three month mark.

Major Depressive Disorder

Typical doses for major depressive disorder is 40mg administered in 20mg twice a day. Treatments of up to 60mg a day can be seen, usually either once a day or in 30mg twice a day.It may require several months of treatment on this drug.

Generalized Anxiety Disorder

Cymbalta is typically started at 60mg once a day although some patients will see 30mg doses for a week before going on to 60mg a day.Control of GAD after the 10 week mark on this drug has not been established.

See the Side effects of Cymbalta

Side effects of Cymbalta:

• Nausea

• Dry mouth
• Constipation
• Loss of appetite
• Tiredness, Drowsiness, Yawning
• Dizziness
• Increased sweating
• Blurred vision

Patient exclusion criteria:

(Things that will keep a person off of being prescribed Cymbalta usually)

• Epileptic Seizure

• Closed Angle Glaucoma
• High Blood Pressure
• A Drop in Blood Pressure Upon Standing
• Hardening of the Liver caused by Alcohol
• Chronic Liver Inflammation
• Hardening of the Liver
• Liver Problems
• Serious Kidney Problems
• Manic-Depression
• Suicidal Thoughts
• Alcoholism

Inflammatory Bowel Disease, or IBD, is the inflammation of the intestines from Crohn’s Disease or Ulcerative Colitis. It gives widespread nutritional difficulties and some with IBD are put on what is called the elimination diet.

Elimination diets are those that will typically have an allergy rate that is low in the foods that are allowed. Food allergies are a common factor in most Inflammatory Bowel Disease cases.

The most common foods that offend typically are wheat or dairy products. People on a standardized elimination diet will have a menu of lamb, chicken, potatoes, rice, banana, apple, cabbage, broccoli, and brussels sprouts. Not a lot of variety, but better for the IBD patient than a nice spicy curry;)

1. Why do you feel that so many chronic pain sufferers go untreated?

It isn’t that they go untreated, it’s that many fail to benefit from either the first treatment (which may not work for them) or from a longer series of treatments ) many of which my only work for a brief period of time or not at all. And, there are also many who do not seek treatment at all, or continually re-injure themselves, or who are afraid to admit to pain which persists after their health care provider has assured them they should be better.
 
2. How can a chronic pain sufferer overcome those that say “You’re still not better” and other deprecating comments?

Smile. Point out that it must be difficult for them to imagine that a pain which they can’t see and are not experiencing could still be bothersome.
 
3. Is there any therapy that can help any chronic pain sufferer, or are they all condition specific?

From my reading and experience (clinical and personal) mindfulness is probably the one therapy which stands  the best chance of being called the universal pain therapy.
 

4. Why did you write your book, Chronic Pain Relief: 12 non-medical approaches, and what do you hope readers take away after reading it?

I wrote the book in order to share a collection of techniques which are easily learned, inexpensive, portable, effective and which have no side-effects. I hope people who are in chronic pain will experiment with the various techniques and perhaps create a synthesis which works for them. Perhaps this will be the only method they use perhaps they will use it in conjunction with more traditional medical/drug interventions.
 
Where do you see chronic pain treatments going in the next 10 years? What do you hope health professionals realize by then?

I’m hoping that more and more physicians will stop being afraid of using appropriate analgesics in appropriate amounts. The fear of creating dependency has created too much needless suffering. I’m hopeful that meditation, mindfulness, and many other holistic approaches (including Chinese medicine, tai-chi, and other balancing techniques) will make greater inroads in Western care and practice. I’m hopeful that more health professionals will work with psychologists, neuroscientists and physiotherapists )to name a few related disciplines) to address the problem of how someone is actually supposed to “live with it” when all treatments appear to have been exhausted.

David Abbey, PhD CPsych

Registered Psychologist (Ontario)