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Has anyone had experience using cymbalta for pain relief?
Chronic Pain | Last Active: Jan 16, 2023 | Replies (177)Comment receiving replies
Hi @AlwaysHopeful, the following info should be useful and might help others on this thread, too.
Whether or not Cymbalta (duloxetine) helps a person depends on several factors, including how the person's body metabolizes the medication.
Most medications are metabolized by the body's cytochrome P450 liver enzyme system. This system contains a ton of different enzymes that are basically genes. Whether or not your body metabolizes a medication properly can depend on three things...
1. Whether or not you are taking a medication that inhibits/induces an enzyme that your body uses to metabolize another medication (or even the same medication). (For example, duloxetine is a substrate of the enzymes CYP1A2 and CYP2D6, which means that these two enzymes metabolize duloxetine in your body. But if you take a medication that inhibits (i.e., slows down) those two enzymes, it will cause you to too-slowly metabolize duloxetine, which means that you will not receive the intended effects. Interestingly, duloxetine actually inhibits CYP2D6. Many medications inhibit P450 enzymes; fewer medications induce them.)
2. Whether or not you have P450 liver enzyme polymorphisms, which means that you posses an enzyme or enzymes that are mutated and make you, organically, metabolize some medications too slowly or too quickly. These polymorphisms are not rare. After years of taking duloxetine, Mayo performed pharmacogenomic testing on me and figured out that I was born with CYP1A2 and CYP2D6 polymorphisms, which explained why I never received the pain relief effects from taking it. (The official diagnosis for this is called CYP450 Deficiency.)
3. A combination of numbers 1 and 2 above. Because I was also taking other medications that inhibited my CYP2D6 enzyme, it made the above situation even worse.
Unfortunately, most doctors only have very rudimentary knowledge of the P450 system, and they don't know enough about drug-drug interactions via these enzymes to recognize of suspect these issues. If you suspect this may be an issue for you, you may be best off talking to your pharmacist first.
Here's where you can look at substrate, inhibitor, and inducer medication info: http://www.mayomedicallaboratories.com/it-mmfiles/Pharmacogenomic_Associations_Tables.pdf
Replies to "Hi @AlwaysHopeful, the following info should be useful and might help others on this thread, too...."
@vickiekay, It shouldn't matter what type of meds you are taking at any given time because this is important genetic information; your body won't be changing. And as we age, we tend to take more and more medications. Maybe state it this way to your doctor.
I traveled to the Center for Individualized Medicine at Mayo - Rochester for my pharmacogenomic testing, but OneOme (who does these tests and was founded by Mayo) now has a much larger test-set that your doctor can order online and they mail it to you... you do a gum swab and FedEx it back to them. It only costs $249 and includes 22 genes (whereas the nine tests I had done a year ago were just under $2,900). Hopefully, you live in a state that has certified OneOme. (My state hasn't, so I wasn't legally able to get my doctor in NY to order it, but I was able get this test done by having one of my Mayo doctors do it because he is in a certified state. We're waiting for the results as I write this.)
(There are other private companies out there who also do these tests, but my PCP prefers that I have this testing done at a place like Mayo because of their reputation and quality.)
And this test set does include testing the genes involved with metabolizing Cymbalta. Go to http://www.OneOme.com for info for you and your doctor.
I suggest doing these tests if possible, and I believe that everyone should have them done. These polymorphisms are not rare.
I was sick for 12 years due to P450 polymorphisms and taking medications that I wasn't able to properly-metabolize. Going to Mayo and having these tests done prevented me from going into drug-induced liver failure and saved my life.
@kdubois It would be wonderful if more doctors and insurance companies ordered and paid for pharmacogenomic testing. I think that we must be mindful that for the majority of us, it simply is not an option.
Recently in Business Insider, I read an article stating doctors spend 13-16 minutes average with each patient. When I go in to my doctor and tell him X drug is giving me side effects or doesn't give me relief, the Dr. goes on to the next drug in the arsenal used for the particular condition.
Next you have the cost of the testing. When medicine became a business, rather than old fashioned patient care, we the patient got lost in the equation. I hope as newer, younger doctors emerge this technology that we have at our fingertips take hold.
It's wonderful that you were able to get this testing. Thanks for making us aware of it.
Agreed, availability and costs are probably the biggest reasons why these aren't more well-known. Hopefully with places like OneOme/Mayo lowering their prices the way they have, pricing will go down across the industry.
Hi, I feel quite privileged to live in Sweden and don't worry about the medicin costs neither doctor or hospitals. Everything is included and if you pay more than 1200 Swedish crowns a year for medicines or for your medical needs, doctors, specialists, massage, any kind of service offered by a medical center, then the rest of the year is free of charge. My Falsodex shots costs 5000:- Swedish crowns each Month. So I pay 1200 Swedish Crowns the first time and then for a year from my purchase every medication written on a recept is free of charge. I really feel for you that the politicians, the insurance companies must decide what kind of medicine you may use. I wish there was another way for you all.. Here, my oncology team try to give me the best regardless of the costs. I wish I could share it with you. Cymbalta has reduced my depression and my anxiety before my death which would be in a year or so. Good luck people!
@saltis, it's just nice to know that it's like this somewhere on Earth!
Thank you so much! This is exciting information! I appreciate your help!
I wish I could help you all. Please understand and accept that I really feel for you. In our struggle to fight back cancer, we don't need to worry about costs or company profits on medication we need to survive. A real big hug!
Thank you for your reply - it was helpful and I admire your courage. I'll be seeing my primary care physician tomorrow and will be asking her for a prescription for Cymbalta. isn't it amazing how we connect. i have just finished watching a series of movies (the Emigrants, The New Land, Here is Your Life, and Everlasting Moments) directed by Jan Troell and so I appreciate the beauty of Sweden. Take care and thank you again for your response. And yes, we don't have a very easy medical system in America!
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I asked for rhis type of testing, but too few of my meds were on their list last fall. Which Mayo site fid your testing?