Detailed Description

Indication

Cymbalta (duloxetine) is a serotonin (5-HT) and noradrenaline (NA) reuptake inhibitor.

Cymbalta is used for the treatment of:

Understanding Depression

Major depressive disorder (depression) is a serious medical condition with a broad range of symptoms. Emotional symptoms can include sadness, loss of interest in things you once enjoyed, thoughts of death or suicide, and feelings of guilt or worthlessness. Physical symptoms can include restlessness or slowness of speech, thought, or activity; trouble concentrating or making decisions; lack of energy; and changes in weight/appetite or sleep. Associated symptoms of depression may include aches and pains, tearfulness, excessive worry over physical health, brooding, obsessive rumination, irritability, and anxiety.

There are many theories about the cause of depression. One common theory is that depression is caused by an imbalance of naturally occurring substances in the brain.

what does depressed patients say?

Someone with depression might think or say any of the following:

  • "I feel sad all the time and just don't feel like myself."
  • "I don't enjoy being with my friends or doing any of the things I usually love to do."
  • "I've been having a lot of trouble sleeping lately."
  • "Sometimes I feel like my life is not worth living anymore."
  • "I feel like I don't have any energy."
  • "I'm not really interested in eating."
  • "Even after a long day, I still feel restless."
  • "I feel so indecisive and that I can't make any decisions."
  • "I just feel so worthless."

Understanding Generalized Anxiety Disorder

Worry and anxiety are natural. They help us prepare to deal with difficult circumstances, whether current or just anticipated. But people with generalized anxiety disorder (GAD) spend most of their time worrying and may experience spontaneous anxiety even when a stressful or threatening situation is not apparent. The worry may become so excessive and persistent that it can limit a person's daily activities.

What Causes GAD?1

While the specific cause of GAD is unknown, doctors have identified a variety of biological and psychological factors. Research shows that GAD can run in families.

GAD Symptoms1

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. The symptoms of GAD include:

  • excessive anxiety
  • can't stop worrying
  • feeling on edge or restless
  • easily fatigued
  • difficulty concentrating
  • irritability
  • problems with sleep
  • tense muscles

1Edgerton JE, Campbell RJ, eds. American Psychiatric Glossary. 7th ed. Washington, DC: American Psychiatric Press, Inc.; 1994.

Understanding Diabetic Nerve Pain

Nerves allow your body to feel temperature, pain, and other sensations. Over time, diabetes can harm nerves in the legs, feet, arms, or hands. The damaged nerves can be overly sensitive. Healthcare providers call this diabetic nerve pain, or diabetic peripheral neuropathy (DNP).

Many People With Diabetes Experience Diabetic Nerve Pain

Some people with diabetic nerve pain feel they must "push through it." Or they think the pain is a sign of old age. Diabetic nerve pain is a real medical condition. The prevalence of DNP is estimated to be 20% to 24% among patients with diabetes1. It is also estimated that 10% to 20% of patients with DNP have pain severe enough to require treatment2.


1http://www.who.int/mediacentre/factsheets/fs312/en
2http://www.diabeteslibrary.org/View.aspx?url=neuropathy_symptoms

Understanding Fibromyalgia

Fibromyalgia is a disorder involving chronic widespread pain, multiple tender points, fatigue, sleep disturbance, and psychological distress1

Characteristic clinical features

  • Widespread body aches, pains, and tenderness2,3
  • Fatigue2
  • Cognitive impairment4
  • Sleep disturbance2
  • Morning stiffness2,5
  • Prior depressive and anxiety symptoms2
  • Impaired social and occupational functioning6

Fibromyalgia pain may be7-10

  • A result of abnormal responsiveness or functioning of the central nervous system (CNS)
    • Eg, central sensitization or functional somatic syndrome
  • A different type of pain syndrome, in which pain is
    • Not inflammatory: Not due to tissue damage or inflammation
    • Not neuropathic: Not due to damage to, or a lesion of, the peripheral nervous system

1Wolfe et al. Arthritis Rheum 1995;38(1):19-28.
2Wolfe et al. Arthritis Rheum 1990;33(2):160-72.
3Yunus. Fibromyalgia and Other Central Pain Syndromes 2005:125-32.
4Park et al. Arthritis Rheum 2001;44(9):2125-33.
5Bennett et al. BMC Musculoskelet Disord 2007;8:27.
6Arnold et al. Patient Educ Couns 2008;73(1):114-20.
7Woolf. Ann Intern Med 2004;140(6):441-51.
8Staud and Rodriguez. Nat Clin Pract Rheumatol 2006;2(2):90-8.
9Gracely et al. Arthritis Rheum 2002;46(5):1333-43.
10Smith et al. Pain Physician 2011;14(2):E217-45.

Cymbalta 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 (OA).

What is Chronic Pain?

Chronic Pain can be described as ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3-6 months1
May involve changes in pain processing and perception2,3

Features of Osteoarthritis (OA)

Characteristic clinical features

  • Clinical presentation4
    • Pain in the joints of hands, knees, hips, and spine
    • Joint deformity and swelling
    • Brief morning stiffness (<30 min)
    • Crepitus
    • Typically worsens with time
  • Radiographic presentation
    • Pain and functional impact poorly correlated with radiographic severity
    • Pain better predictor of disability than radiographic grade

Functional Impairment in OA

  • Limitations in movement are very common6
  • Restricted mobility - OA of large joints
  • Restricted range of motion - OA of small and large joints
  • ~25% of patients cannot perform main activities of daily life6
  • ~25% of the visits to primary care physicians are due to OA7,8
  • OA accounts for greater loss of independence than any other disease, especially in the elderly8

What is Chronic Low Back Pain?

  • Duration of >3 months with frequent recurrence9,10
  • Multifactorial disorder9,10
  • Differential diagnosis: disc degeneration, herniated discs, spinal stenosis, scoliosis, osteoporosis, fracture, spondylitis11,12
  • 3 broad diagnostic categories9
    • Nonspecific (85%)13
    • Associated with radiculopathy or spinal stenosis
    • Associated with another spinal cause

1ACPA. ACPA Consumer Guide to Pain Medication & Treatment, 2010.
2Marcus. In: Chronic Pain: A Primary Care Guide to Practical Management, 2009.
3National Pharmaceutical Council Inc. Pain: Current Understanding of Assessment, Management, and Treatments, 2001.
4Sarzi-Puttini et al. Semin Arthritis Rheum 2005;35(1):1-10.
5Salaffi et al. Clin Rheumatol 2005;24(1):29-37.
6Wieland et al. Nat Rev Drug Discov 2005;4(4):331-44.
7Green. Clin Cornerstone 2001;3(5):50-60.
8Bello et al. Curr Med Res Opin 2006;22(11):2221-32.
9Chou et al. Ann Intern Med 2007;147(7):478-91.
10Von Korff and Saunders. Spine (Phila Pa 1976) 1996;21(24):2833-7.
11O’Sullivan. Man Ther 2005;10(4):242-55.
12Airaksinen et al. Eur Spine J 2006;15(2 Suppl):S192-300.
13Deyo et al. N Engl J Med 2001;344(5):363-70.

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Last Update: 12 Oct 15

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