Your doctor told you that you have chronic pain and gave you a prescription for Duloxetine.
You wonder what is this medication?
You heard that this is a antidepressant, but why do you need an antidepressant to treat
pain?
Today I’ll answer some common questions that patients ask me when I give them a prescription
for duloxetine: How does it work?
What kind of pain is duloxetine used for?
When will it start working?
Can duloxetine cause weight gain?
Is duloxetine better than the other painkillers?
Can people get addicted to duloxetine?
Will it help me sleep?
My pharmacist told me I need to stop smoking if I want to take duloxetine
Can I take duloxetine if I am taking another medication for depression?
So, let’s talk about duloxetine today.
1.
How does duloxetine work?
Duloxetine works by increasing the neurotransmitters in the brain: serotonin and noradrenaline.
These two neurotransmitters are important in some parts of the brain to fight the pain.
I explained in another video “What is chronic pain” that it is a disease of the pain system.
When the pain system is malfunctioning, it is like the alarm of the house that is too
loud, or there are false alarms, or the alarm is going off all the time, constant buzzing
in your head.
Chronic pain is like that.
The pain sensors are over sensitive, the volume of pain is increased and there are false alarms.
And this happens all the time, 24 hours a day.
One way to fix the pain system is by regulating the neurotransmitters in the brain.
There are many other ways to fix the pain system, and you probably have heard me talking
about the toolbox of 5M IS.
You should have many tools in your toolbox to fix your pain system.
Medication is only one of the tools, it is one of the Ms.
2.
What kind of pain is duloxetine used for?
Duloxetine has been approved for neuropathic pain that is caused by diabetes.
We call this painful diabetic neuropathy.
Symptoms may include burning, tingling, numbness in both feet and both hands.
So, because duloxetine treats neuropathic pain from diabetes, we use it off label for
other types of neuropathic pains.
If you want to learn about what is neuropathic pain, I have another video.
I’ll put the link in the description below.
Some examples of neuropathic pain include herpes zoster, post-herpetic neuralgia, multiple
sclerosis, radiculopathy, like cervical or lumbar radiculopathy, pain after spinal cord
injury or stroke.
Duloxetine has also been approved for people with fibromyalgia, and it is specially good
for them because fibromyalgia is a condition that usually shows signs of depression and
anxiety.
And because duloxetine is an antidepressant, it will help both, the pain and the mood problem.
Duloxetine also has been approved for chronic low-back pain and osteoarthritis of the knee.
I particularly do not use duloxetine for these conditions, I find that my patients report
better pain relief with other interventions like exercises and injections.
But there are some cases of chronic back pain and knee pain that do not resolve with exercises
and injections, and they have some components of nerve injury around the back or the knee.
For example, if they had a previous surgery to the knee or to the back, then there were
nerves that were cut by the surgeon, and then they may result in neuropathic pain.
Now, I always explain to my patients that they should expect that the duloxetine will
eliminate their pain completely.
That is an unrealistic goal.
If they think that this pill, or any painkiller completely eliminates chronic pain, then they
will be disappointed.
I tell them that we expect the pain to get at least 30% better.
That is why it is important to measure the pain intensity and function before we start
duloxetine.
So, the next question that I get is:
3.
When will it start working?
Before I continue, let me remind you that this video is not intended to replace medical
advice.
It is for educational purposes only.
You should contact your doctor for a proper diagnosis and treatment plan for you.
In case of emergency, go to the nearest emergency department or call an ambulance.
Well, duloxetine will take some time to start working.
It has to be taken every day and it will slowly increase the neurotransmitters in the pain
system.
We don’t want to give a high dose to start, this is to let your body to get used to this
medication.
Initially there might be side effects, and these side effects may include nausea, dry
mouth, dizziness, constipation, fatigue and in some people they will get too sleepy, and
in others they will have insomnia.
These side effects are dose-dependent, which means that they are more severe with higher
doses.
So, if I give you a higher dose to start, you may have severe side effects and will
abandon this treatment.
That is why we start with a low dose, the lowest capsule contains 30 miligrams.
Then, we start increasing to 60 miligrams and 90 miligrams.
To have results for pain relief we don’t need to go higher than 90 miligrams.
Then, the body gets accustomed to the side effects and you don’t have them anymore.
But you need to take the duloxetine for at least 4 weeks to notice the 30% pain relief.
4.
Can duloxetine cause weight gain?
Duloxetine has very minimal effects on weight.
If you know someone who takes duloxetine and you would like to send this video, just press
the share button below.
5.
Is duloxetine better than the other painkillers?
Duloxetine is not a painkiller, it is an antidepressant medication.
It is also used to treat major depressive disorder and generalized anxiety disorder.
We may use duloxetine combined with other painkillers and anticonvulsant medications.
6.
Can people get addicted to duloxetine?
No, duloxetine is not a medication that leads to addiction, however, because some people
get sleepy with this medication, there may be some abuse of this medication.
Which leads to the next question: 7.
Will duloxetine help me sleep?
It is interesting that this is unpredictable.
We tell the patient who never used duloxetine to take at night, once at day before bedtime,
because it usually causes sleepiness.
However, I inform the patient that in some people it will cause insomnia, and if this
is their case, then they can switch to taking it in the morning.
8.
My pharmacist told me that I need to stop smoking if I take duloxetine.
Is that true?
No, you don’t need to stop smoking, however, we know that smoking leads to some changes
in how your liver uses duloxetine, so people who smoke may need a higher dose of duloxetine
to get the same benefits than a non-smoker.
9.
Can I take duloxetine if I am taking another medication for depression?
That has to be discussed with your doctor or your pharmacist.
There are a variety of individual situations, and each is different.
The answer is “It depends on your case”.
. That is all for today.
I hope I answered all your questions about duloxetine.
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Good bye!