DrJEDtalks: Nerve pain Meds: Cymbalta only

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In a previous video we talked about the various causes

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of neuropathic pain that is nerve pain.

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Here we’ll focus primarily on the medical treatments.

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So to review, in general, causes

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of nerve pain may be from the neural entrapments,

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the pinched nerve in the, the neck, the low back,

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or other places in the body versus the neuropathies,

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peripheral neuropathy, diabetic peripheral neuropathy.

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So what do we do about this?

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Well, the treatment of nerve pain can be very difficult.

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Nerve pain can be very resistant to standard medications

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to treat pain such as ibuprofen.

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Tylenol doesn’t really seem to do much.

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Even the narcotic pain medicines don’t treat

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nerve pain very well.

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So what are the standard treatments for nerve pain?

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The primary medical treatments for neuropathic pain

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that is nerve pain are the big three.

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So, uh, the most commonly used is gabapentin followed

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not in two distant second by Lyrica, also called pregabalin,

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and then Cymbalta.

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Those would be the big three medications that can be used

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to treat neuropathic pain, to treat nerve pain.

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Cymbalta, there’s some literature that suggests

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that Cymbalta may be the single best medication

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to treat neuropathic pain.

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So why don’t I begin with Cymbalta? Many reasons.

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Some of the main reasons might be just

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insurance stipulations.

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Myself, I’m a physiatrist. I’m not a psychiatrist.

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Psychiatrist oftentimes use Cymbalta

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to perhaps treat depression and

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or other various mood disorders.

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However, as that is not in my wheelhouse, I’m using Cymbalta

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to treat neuropathic pain.

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Typically, the guidelines that are placed there by insurance

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stipulate that I must try other medications first, try

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and fail other medications

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before they will approve Cymbalta.

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So that will oftentimes include dosing

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and trialing the gabapentin.

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Sometimes going up trying the Lyrica.

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And if a person is still having neuropathic pain,

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then progressing to the Cymbalta.

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Cymbalta dosing is a little bit different.

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It is oftentimes dosed either once daily or twice daily.

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I typically do it twice daily myself.

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’cause once again I’m trying to treat neuropathic pain

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and not a mood disorder.

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I’ll begin very low.

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Say for example, Cymbalta 20 milligrams twice a day,

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maybe do that for a month.

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You come back, we might go to 30 milligrams twice a day.

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You might go to 40 milligrams twice a day,

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up to 80 milligrams.

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Occasionally some patients will want to switch over

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to 80 milligrams once a day.

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In that case, that is acceptable in that case.

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Nothing wrong with that. And um, once you’re at 80

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milligrams, there is, uh, literature that suggests

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that increasing the dose beyond that won’t make much

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of a difference in decreasing the pain.

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However, I have a couple patients that say

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Otherwise that say that once they got to 120 milligrams,

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it made a big difference for them.

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However, in general, once you’re up

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to 80 milligrams a day on Cymbalta,

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you’re probably not gonna get much more benefit in

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decreasing that neuropathic pain.

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So that’s a quick review of the medication dosing

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and the medication use to treat neuropathic pain.

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Now there are many other specific treatments

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for neuropathic pain,

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however, those are very specific

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to very specific pathologies.

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If you have neuropathic pain, you begin with gabapentin,

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Lyrica, Cymbalta.

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If you continue to have neuropathic pain, you speak

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with your physician and see if there are other options

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that you can treat your neuropathic pain

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to help you live your life, less pain,

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improve your function, improve your mood,

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just improve your quality of life.

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So hopefully you find this helpful.

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Once again, continue to take care of yourselves and be well.