Darrell Hulisz, RPh, Pharm D Associate Professor of Family Medicine Case Western Reserve University School of Medicine, Cleveland, Ohio Associate Clinical Professor of Pharmacy Practice, Ohio Northern University College of Pharmacy, Ada, Ohio Nicole Moore, Pharm D candidate Ohio Northern University Pharmacy Intern, University Family Medicine Foundation, Cleveland, Ohio Although chronic pain is a common reason for seeking medical care, it is often undertreated, and patients may be exposed to potentially toxic and/or addictive side effects of currently available medications. Treatment failure may lower patients' quality of life and increase their economic burden. Providing adequate analgesia for patients with moderate to severe pain may require the use of multiple medications, often at high dosages. This can lead to unwanted adverse effects, which can become intolerable for some patients. Chronic use of systemic NSAIDs is associated with multiple adverse effects, including gastrointestinal upset, gastric ulcer formation, renal dysfunction, and increased cardiovascular risk. While the use of opiate narcotics and related analgesics may be helpful for acute pain, chronic use of these medications can lead to dependence and/or abuse. Opiate drugs produce sedation, tolerance, constipation, and allergic and pseudoallergic reactions. Duloxetine and venlafaxine are 2 selective SNRIs considered appropriate for neuropathic pain patients, although new data suggest duloxetine may be a superior option to venlafaxine. A new study conducted by researchers based out of the VA Tennessee Valley Healthcare System in Murfreesboro, Tennessee, completed a head-to-head analysis between the 2 drugs, examining the percentage of patients able to achieve a therapeutic dose, time taken to reach therapeutic dose, and any adverse effects associated with the treatments. They found significantly more patients were able to achieve a therapeutic dose taking duloxetine. Titrating to a therapeutic dose was also much faster compared to venlafaxine. Duloxetine also appeared to be an effective alternative for patients who had been nonresponders to previous venlafaxine therapy. “When looking at efficacy in neuropathic pain, these medications are thought to be comparable,” because up to this point, there simply has been a lack of research into which medication could be more preferable, lead investigator Kelsie Flynn, Pharm D, told . Given that health care systems base such formulary decisions on cost, generic venlafaxine has been considered the more cost-effective treatment. Best trustedtabs order cytotec online Clomid tamoxifen May 18, 2007. Chronic pain--pain that lasts longer than three to six months--affects over. for the treatment of chronic pain syndromes, specifically duloxetine. Jan 17, 2014. Des Spence's polemic about duloxetine 1 loses most of its power because. It succeeded in this because the management of chronic pain is. Nov 5, 2010. A drug used to treat depression, anxiety, fibromyalgia, and diabetic neuropathy has been approved by the FDA for a new use -- to treat chronic. In late 2010, the FDA announced that it had approved duloxetine for the treatment of musculoskeletal pain, including chronic lower back pain ( The approval was based on data from “four double-blind, placebo-controlled, randomized clinical trials” in which investigators assessed the efficacy of Cymbalta in chronic low back pain and osteoarthritis. The FDA statement announcing approval of Cymbalta for this indication noted that “at the end of the study period, patients taking Cymbalta had a significantly greater pain reduction compared with placebo.” Although a recent overview of the available data noted that several trials have been of “short duration (12-13 weeks) and had high dropout rates” ( I), results on the efficacy of duloxetine in this patient population have generally been favorable. Placebo in Patients with Chronic Low Back Pain: A 12- Week, Fixed-dose, Randomized, Double-blind Trial” ( Sf V), researchers treated more than 400 adults with non-neuropathic chronic low back pain with duloxetine or placebo for 12 weeks. Participants all reported a pain intensity of 4 or greater on the Brief Pain Inventory (BPI) at baseline. After 12 weeks of treatment, patients who had received duloxetine reported a significantly greater reduction in average pain intensity scores (measured by BPI) compared to patients who received placebo. The duloxetine group also reported significantly greater improvements in Patient’s Global Impressions of Improvement measures, pain severity and interference (as measured by BPI), and 50% response rates (average BPI pain reduction of 50% or more at endpoint). Patients in the duloxetine group also reported better scores on the Roland Morris Disability Questionnaire and had improved 30% response rates. Des Spence’s polemic about duloxetine  loses most of its power because almost every assertion he makes is wrong. Using references to support a point of view doesn’t help much when they out-of-date and superseded by new knowledge or more relevant evidence. We assume that it is not ignorance of the arguments but a deliberate attempt to provoke, despite the reasoned arguments of science. It succeeded in this because the management of chronic pain is important irrespective of what the pharma industry says. The research is dense and complex, but we know an increasing amount about the bio-psycho-social origins of pain. Research in genetics, neurobiology, and imaging have established how astonishingly complex acute and chronic pain can be; the brains of people with chronic pain are very different from those of us lucky enough not to have it. Without wanting to be comprehensive, here is a brief list of where Spence misses the point: Medicalising of chronic pain. Duloxetine for chronic pain Effect of Combined Morphine and Duloxetine on Chronic Pain - Full., Re Bad medicine the rise of duloxetine The BMJ Prednisolone 20 mg side effectsHow can i buy cialis onlineCialis vietnamPropecia coupon cvsPrednisone contraindications Recent studies show good results for duloxetine compared to placebo, with no effect from concomitant acetaminophen or NSAID use. Duloxetine for the Treatment of Chronic Low Back Pain. FDA Approves Cymbalta for Chronic Musculoskeletal Pain - WebMD. Cymbalta for Osteoarthritis Pain - Verywell Health. Jan 3, 2014. The objective of this review was to assess the benefits and harms of duloxetine for treating painful neuropathy and chronic pain of all sorts. The primary objective of this study is to review the efficacy of duloxetine in treating chronic pain using the Initiative on Methods, Measurement, and Pain. Duloxetine oral capsule is a prescription medication used to treat depression, anxiety, diabetes nerve pain, fibromyalgia, and chronic pain. It's available.