A 48 year old female has a history of diabetic neuropathy and has been placed on Cymbalta (duloxetine). The patient has taken it for three days and is feeling pretty fatigued throughout the day from it. She asks, “How long does it take Cymbalta to work for pain?”
I’ve looked for literature on this in the past, and I can’t seem to find much on this topic. In the absence of side effects, most antidepressants (when used for depression) are given a minimum of 6-8 weeks as an appropriate trial to begin to see benefit. Some might argue to give it 3-6 months especially if a partial response has been noted.
Does this length of 6-8 weeks apply to the analgesic effect of Cymbalta? Again, I don’t think we have a great answer for this one. Not having great clinical literature to help guide our decision, I think a little common sense can get us there.
The patient is having trouble with potential side effects. My first question would be what dose is it? If we started at 60 mg, maybe that is a little too much. Next, I would ask what time she is taking the dose. Most patients will usually take the dose in the morning. If fatigue is bothersome throughout the day, I would consider switching the dosing to the evening.
In summing up this scenario, I would probably encourage the patient to switch the dosing to the evening timeframe and try to continue to take it for at least a couple of weeks unless the side effects become unbearable. I would ideally like to get this patient out to the 6-8 week mark before considering this treatment failure.
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What would you do for the pain in the meantime?
This question came up with one of my patients last week! I believe that part of the analgesic effect of Cymbalta is derived from its antidepressant effect. I told my patient to give it 4-6 weeks before deciding whether or not it’s helping with his neuropathy.
I was put on cymbalta 30 mg for 6 days and then 60 mg . I drink my capsule at nighttime and have a huge relieve in neuropathic pain of mononeuritis multiplex, within the six days of 30 mg already. I sleep much better pain in early morning hours less and could be more comfortable with pain during the day with bigger spaces in between pain tablets again. I never! Thought a antidepressant which boost serotonine can be so helpful in my very painful two years battle with my pain. I have no side effects.
Thank you for your encouragement. I have completed two weeks on it for nerve pains. With slight improvement.
Just started mine tonight for joint pain.