Cymbalta was original developed for depression. The reason why most doctors use this for pain management is because it's safe, it also builds up serotonin in the brain. Serotonin is a chemical that helps cut the pain level in your brain or in your brain transmitters. You can never take serotonin with any strong tier 3 pain medication. It might put you into a depressant without you knowing it. I have gone to my recent Pain management doctor for 23 years. I am bipolar, but it has been behind closed doors for 42 years. I became bipolar when I was 18 and I saw a psychiatrist to the age of 28. I was taught how to conquer my bipolar to mental exercises medication, and clonazepam at 6 mg a day. This helps to control my anxiety. As soon as I get that control I developed diabetic autonimic peripheral polyneuropathy (I have three forms of the neuropathy that have combined together) I am in nonacute pain for 24 hours a day seven days a week since the year 2000. I have a double spinal cord stimulator with 20 leads going to my hand to cut the pain signals down. I was on fentanyl patch 100 MCG every 48 hours for a long-term pain and short term pain I was on oral fentanyl 800 MCG three times a day. Before I got the stimulator, I was on physical therapy and deep massage heat. However, once I got the stimulator, double stimulator. My pain management doctor I had to stop all therapy and concentrate medication. Pain management doctor anesthesiologist which is a great help to. He is also a teaching doctor meaning he explains the full detail why you need this medication and what is it going to do. Cymbalta. never worked for me, Lyrica never worked for me on pain. Gabapentin was a joke. It just made me sleepy the entire day and this was before I went out on disability. I could not go to work. I never wake up.
I have had in 20+ years about 25 nerve blocks. I almost forgot the stimulator. My C3 was cut. One believes went down the epidural canal to touch the nerves in my arms. I had carpal tunnel surgery and 1999. I have one iPad Pro tablet with the desktop M1 processor. this tablet to for medical apps, professional medication apps, 3D Human body app ... I can show exactly where my pain is coming from. I use apple pencil and a white board. I take screenshots of the 3D human body. I usually show the bone, nervous system, some muscle , and the heart - since my Small Fiber Neuropathy attacked my electrical system of the heart, and that I had to get a double or dual chamber pacemaker. I went one year with severe chest pain. it took all of my doctors, that is why doctors to brainstorm and track down what was really happening. Because my heart was perfectly fine on the inside. after been in the Cath lab 4 times in one year. I been a diabetic for 43 years and with in the last 6 years I was placed on an insulin pump. Now I have Neuropathy Edema , since I can no longer take fentanyl , I had to drop to slow release and fast release Morphine for 4 + years. It really helps with my nerve pain. When my surgeon did the double spinal cord stimulator , it took 16 hours. . The main key is finding a great pain management doctor. Always do a background check on each doctor that you plan to see . The web site or App , Healthgrades, is a great resource in finding full details about your doctor. Customers constantly right in that application about the office staff, and about the doctor, the doctor bedside manner, if he really cares about the patient and the treatment , how many lawsuits against the doctor.