In more detail; the case description according to the latest LUMBOSACRAL SPINE MRI report (1) Status post operative showing spinolaminectomies of L3 & L4 vertebra by pedicular 3 metal plates and 6 screws. (2) Forward slippage of L4 over L5 vertebra with consequent mild compromise of both neural exit foramina. (3) Reduction of height of L3/L4 & L4/L5 intervertebral discs and loss of normal bright T2 signal intensity of L1/L2, L2/L3 and L5/S1 intervertebral discs with marginal osteophytic lipping and degenerative marrow changes of the opposing lumber vertebral and plates. (4) L2/L3 posterior and left posterolateral disc protrusion. The general opinion was (1) First degree spondylolithesis of L4 Vertebra. (2) L3/L4 through L5/S1 epidural and bilateral peri- neural scarring with signs of intra- dural adhesions "arachnoiditis" (3) L2/L3 posterior and left posterolateral disc protrusion. The previous diagnosis was done two years after the metal plate’s fixation surgery. Currently the patient is suffering from severe pains in the buttocks left side especially around the sacrum and down the bottom side of the left leg with frequent numbness all over the left leg; recently pains appeared at the right side buttocks also, upon visiting an orthopedic physician he prescribed “Cymbalta 60 mg’’ for the patient until next visit which is set 30 days later than the first visit, my question is dose “Cymbalta 60 mg’’ will do any good for the patient with such diagnosis? And if dose, why and How? Thanks & best regards.
I cannot answer the "why & how" with any technical expertise, so I'll give you my answer based on what I know. If this was prescribed I have to believe the Dr is well aware of the diversity of this drug, which by the way I had to stop taking after just 3 weeks because of horrid side-effects.
One of the applications is indeed for pain, regardless of the cause of the pain. Will it do any good? That can only be answered by taking it as prescribed and seeing what comes of it over the 30 days. So it's a direction of not questioning the Dr's recommendation/prescription here of all places. The last thing any (most) of us want to do is steer you away from a physician's directions. Take (or have "the patient" take) the medication as the Dr ordered and go from there. I really hope this helps.
It has been known to have benefit for nerve related pain. I did take Cymbalta for quite some time but I did not get the other benefit. I have nerve damage following a back surgery and other nerve stuff.
I also am not sure of the "why" and/or "how"... just that for some people it works. The side effects do pass in time for most people. That is the upset stomach or nausea.
By the way, 60mg isn't too high and if you start this medication, I wouldn't start that high... I would ask for the lowest dose because you should be getting used to it first. Like 20's, for instance, is a good place to start and slowly working your way up to 60mg. Your doctor could help a lot here. I think 60mg right off the bat is going to more than upset your stomach. But I had great results as far as having it for "mood" stabilization... it was great!
I hope that helps you...
Cymbalta (duloxetine) is indicated for the management of chronic musculoskeletal pain. This has been established in studies in patients with chronic low back pain (CLBP) and chronic pain due to osteoarthritis. Duloxetine is used to treat depression and anxiety. In addition, duloxetine is used to help relieve nerve pain (peripheral neuropathy) in people with diabetes or ongoing pain due to medical conditions such as arthritis, chronic back pain, or fibromyalgia (a condition that causes widespread pain).
Duloxetine may improve your mood, sleep, appetite, and energy level, and decrease nervousness. It can also decrease pain due to certain medical conditions. Duloxetine is known as a serotonin-norepinephrine reuptake inhibitor (SNRI). This medication works by helping to restore the balance of certain natural substances (serotonin and norepinephrine) in the brain.
Chronic Musculoskeletal Pain
The recommended dose for Cymbalta is 60 mg once daily. Dosing may be started at 30 mg for one week, to allow patients to adjust to the medication before increasing to 60 mg once daily. There is no evidence that higher doses confer additional benefit, even in patients who do not respond to a 60 mg dose, and higher doses are associated with a higher rate of adverse reactions
Mechanism of Action
Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation of serotonergic and noradrenergic activity in the CNS. Preclinical studies have shown that duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake. Duloxetine has no significant affinity for dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors in vitro . Duloxetine does not inhibit monoamine oxidase (MAO).
Cymbalta is in a class of drugs known to affect urethral resistance. If symptoms of urinary hesitation develop during treatment with Cymbalta, consideration should be given to the possibility that they might be drug-related.
Duloxetine has an elimination half-life of about 12 hours (range 8 to 17 hours) and its pharmacokinetics are dose proportional over the therapeutic range. Steady-state plasma concentrations are typically achieved after 3 days of dosing. Elimination of duloxetine is mainly through hepatic metabolism involving two P450 isozymes, CYP1A2 and CYP2D6.
Studies in Chronic Low Back Pain
The efficacy of Cymbalta in chronic low back pain (CLBP) was assessed in two double-blind, placebo-controlled, randomized clinical trials of 13-weeks duration (Study CLBP-1 and Study CLBP-2), and one of 12weeks duration (CLBP-3). CLBP-1 and CLBP-3 demonstrated efficacy of Cymbalta in the treatment of chronic low back pain. Patients in all studies had no signs of radiculopathy or spinal stenosis.
Study CLBP-1: Two hundred thirty-six adult patients (N=115 on Cymbalta, N=121 on placebo) enrolled and 182 (77%) completed 13-week treatment phase. After 7 weeks of treatment, Cymbalta patients with less than 30% reduction in average daily pain and who were able to tolerate duloxetine 60 mg once daily had their dose of Cymbalta, in a double-blinded fashion, increased to 120 mg once daily for the remainder of the study. Patients had a mean baseline pain rating of 6 on a numerical rating scale ranging from 0 (no pain) to 10 (worst possible pain). After 13 weeks of treatment, patients taking Cymbalta 60-120 mg daily had a significantly greater pain reduction compared to placebo. Randomization was stratified by the patients' baseline NSAIDs-use status. Subgroup analyses did not indicate that there were differences in treatment outcomes as a function of NSAIDs use.
Study CLBP-2: Four hundred and four patients were randomized to receive fixed doses of Cymbalta daily or a matching placebo (N=59 on Cymbalta 20 mg, N=116 on Cymbalta 60 mg, N=112 on Cymbalta 120 mg, N=117 on placebo) and 267 (66%) completed the entire 13-week study. After 13 weeks of treatment, none of the three Cymbalta doses showed a statistically significant difference in pain reduction compared to placebo.
Study CLBP-3: Four hundred and one patients were randomized to receive fixed doses of Cymbalta 60 mg daily or placebo (N=198 on Cymbalta, N=203 on placebo), and 303 (76%) completed the study. Patients had a mean baseline pain rating of 6 on a numerical rating scale ranging from 0 (no pain) to 10 (worst possible pain). After 12 weeks of treatment, patients taking Cymbalta 60 mg daily had significantly greater pain reduction compared to placebo.
Is that some of the answers you were looking for?
I do agree with everyone else when it comes to listening to the Dr. first, but I have to say that this question related to this patients obvious pain levels really makes me mad. The reason why is because I cannot tell you how many Dr.'s said that Opiates do not help Fibromyalgia/Chronic Myofascial Pain conditions which is a crock of #$%^&. They just don't want to prescribe anything that is a "drug" because the DEA is coming down so hard on Dr.'s So basically because of all the people out there that are abusing drugs, the people who really need them are not getting them. In addition, statistics show that only 1% of people prescribed narcotics for the use of chronic pain conditions become psychologically addicted to them.
Do they get physically addicted, yes, but that is not as much of a big deal as it is to suffer needlessly because of Dr.'s who are running scared. They made an oath to do no harm and under prescribing pain medications does a great deal of harm to the patient. Just my angry two cents worth.
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