Does Cymbalta help with nerve pain? (3+ studies)

In this article, we will discuss whether or not Cymbalta can help with nerve pain, what research has to say in this regard, the side effects that can occur and precautions to be taken when using Cymbalta for nerve pain. We will also discuss what should be done if Cymbalta is not working for you, complementary therapies available when using Cymbalta and alternatives to Cymbalta for nerve pain.

Does Cymbalta help with nerve pain?

Yes, Cymbalta can help with nerve pain. It cannot treat or reverse any sort of nerve damage but can help in relieving the pain. Cymbalta has been approved by the FDA for the treatment of diabetic peripheral neuropathic pain (DPNP) and is also used ‘off-label’ for chemotherapy-induced peripheral neuropathy (1,2).

Nerve pain (also known as neuralgia or neuropathy) is a characteristic of nerve damage. The damage can be due to many different causes. Some causes of nerve damage are diabetes, tumours, chemotherapeutic agents, alcohol, toxins and nutritional deficiencies (3).

Cymbalta (Duloxetine) is an antidepressant belonging to the class of serotonin and norepinephrine reuptake inhibitors (SNRIs). The mechanism of action of Cymbalta includes the increase of serotonin and norepinephrine levels in the brain (2).

Cymbalta helps with nerve pain by inhibiting the reuptake of serotonin and norepinephrine by the nerve cells in the brain. Both these neurotransmitters are responsible for pain modulation. So by decreasing their reuptake, Cymbalta helps relieve neuropathic pain (2).

What does research suggest?

Many research studies have assessed the safety and efficacy of Cymbalta when used for neuropathic pain and have concluded that Cymbalta is effective in relieving neuropathic pain.

A study assessing the efficacy of duloxetine in the treatment of DPNP concluded that a dose of 60mg once daily and twice daily is safe and effective for individuals receiving each dosage (4).

Another study comparing the safety and efficacy of 60mg of Duloxetine once or twice daily, in 348 patients of DPNP stated that Duloxetine in these dosages was safe and effective for neuropathic pain (5).

A research study assessed the efficacy of Duloxetine in relieving neuropathic pain and recorded that a dose of 60mg was efficacious in the treatment of DPNP. This study saw a positive response of Duloxetine towards pain and quality of life. However, a slightly increased blood sugar was also noted in individuals who received Duloxetine (6).

Another clinical study assessed the efficacy of Duloxetine in patients with DPNP and stated that any dose greater than 60mg is not more effective or does not provide more pain relief. However, the risk and incidence of side effects increases (7).

What are the side effects of using Cymbalta for nerve pain?

Cymbalta has to be used with caution when prescribed for neuropathic pain. Some individuals may start experiencing common side effects like (7):

• Nausea
• Dizziness
• Somnolence
• Insomnia
• Dry mouth
• Sweating
• Constipation
• Tremors
• Fatigue
• Diarrhoea

Sometimes side effects of Cymbalta can get severe to the extent that some patients may discontinue treatment. Some serious side effects are (1):

• Suicidal thoughts and ideations
• Agitation
• Abnormal bleeding
• Activation of mania
• Seizures
• Hyponatremia
• Blood pressure changes

If you feel that Cymbalta is inducing side effects that are not manageable, you should consult your healthcare provider for a detailed evaluation of your symptoms and underlying causes.

What precautions to take when using Cymbalta for nerve pain?

If you have been prescribed Cymbalta for nerve pain, you should keep the following points in mind:

• Monitor your blood glucose levels regularly.
• Keep track of, and record your symptoms.
• Let your healthcare provider know about previous treatments for nerve pain.
• Make sure your doctor knows any allergies or medications you are currently taking before starting Cymbalta.
• Avoid alcohol and limit caffeine intake. 
• Stay adequately hydrated.
• Try to maintain a healthy lifestyle, with an ample amount of exercise.

Keep in mind that every individual may react differently to Cymbalta when used for nerve pain. Some individuals may respond positively, while others even after taking all precautions, may not experience the required pain relief.

What to do if Cymbalta is not working for nerve pain?

If you feel Cymbalta is not working for your nerve pain or is causing more side effects than benefits, you should immediately consult your healthcare provider. Your doctor will assess your situation and make changes to your regimen.

Your doctor may suggest complementary therapies for the treatment of nerve pain or may change the medication to any other approved medication for nerve pain.

Do not, under any circumstance, make changes to your prescription on your own. Also, you should not abruptly discontinue Cymbalta. Always make sure any changes to your prescription or dosage are under the recommendation of a health provider.

What alternative therapies help with nerve pain while on Cymbalta?

Some complementary therapies can help patients with nerve pain while taking Cymbalta. Some of these are as follows (8):

Acupuncture

This technique may help some individuals to increase the therapeutic effect by stimulating specific nerve pathways.

Magnets

Using static magnets for diabetic neuropathy has been shown to reduce numbness and tingling, and provide pain relief from nerve pain.

Electrostimulation

Electrical nerve stimulation has shown promising results for patients when used for diabetic neuropathy.

Herbal medicine

Geranium oil, St. John’s wort, and even cannabis can help relieve nerve pain. The use of such herbs should not be done without permission from your healthcare provider.

Supplementation

Supplements like antioxidants, vitamin B1, acetyl-l-carnitine and sometimes even topical capsaicin can provide relief from diabetic neuropathy.

What other medication options are available for nerve pain?

Nerve pain can also be treated or managed through alternative medications. The choice of medication depends upon the response of the individual. Some other medications used to manage nerve pain are:

Anticonvulsants

Primarily used to control seizures, but medications like Pregabalin and Gabapentin can also help in the management of nerve pain.

Antidepressants

Apart from Cymbalta, other SNRIs like Venlafaxine, tricyclic antidepressants (TCAs) like amitriptyline or SSRIs like fluoxetine have been used to manage neuropathic pain.

To the best of my knowledge and research, Cymbalta can help in managing nerve pain. However, the extent of pain relief it can provide varies from person to person. Sometimes the side effects can cause the discontinuation of therapy.

In my opinion, you should consult your healthcare provider if you have nerve pain, let them assess your situation, determine the underlying cause and recommend a personalised management plan according to your needs. Do not make any amends to your prescription on your own.

References