Cymbalta for chronic pain?

[425runner]

My GP gave me two weeks worth of Cymbalta 30mg samples, saying that it'd help me with the chronic pain I've been dealing with since September, caused by occipital neuralgia.  A blast of cold air really makes the pain untolerable and I don't want to be popping 7 tylenols a day for the next few months.

I'm also taking Wellbutrin XL 150mg for depression, Klonopin 1mg as needed for anxiety, and recently my doctor added Aderrall 10mg/day to help with my ADD-PI.

What's so different about Cymbalta then other SNRI's?  Is it the serotonine that helps with pain?

Please advise,

Thank you!!

[425runner]

Yes, but Welbutrin is already NDRI, so why not just add Lexapro to the mix?  I need the dopamine to get things done and it's been working great!

I suffer from chronic occipital neuralgia worsened by exposure to cold air or stress. Is there anything else that might help with this?

Thank you!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Cymbalta (i.e., duloxetine) has a combination mechanism of action involving serotonin and norepinephrine making it useful in depression and also neuropathic pain.

When a peripheral nerve is injured there is an increase in pain sensitive fibers leading to increase pain recognition. This causes a change in central (i.e., brain/spinal cord) recognition of pain. One major neurotransmitter involved in this is norepinephrine. Cymbalta works to modulate this change.

Also, chronic pain usually has a strong underlying psychiatric mechanism which serotonin plays an important role.

Effexor (or venlafaxine) is another SNRI that is similar to duloxetine in mechanism and usefulness.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.