Cymbalta Approved for FMS

Discussion in 'Pain Medicine' started by lobelsteve, Jun 17, 2008.

  1. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Get ready for direct to consumer marketing, a visit from your Lilly rep, and a barrage of TV news updates.

    FDA approved Cymbalta for FMS on 6/16/08
     
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  3. Disciple

    Disciple Senior Member

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    Another round of nice dinners coming up.
     
  4. PMR 4 MSK

    PMR 4 MSK Large Member
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    And more whining about side effects...

    Just gave some to a FMS pt today, even before reading this. She's absolutely nuts - I saw her once last year and recommended an MRI of her L-Spine, she swore she could only do it under general anesthesia. Didn't come back to me. Now she's been seeing a pain doc across town who has no office of his own, he consults in other docs offices, mainly chiro's, has her on Duragesic 100, plenty of hydrocodones and did an apparent blind TEFSI without a prior MRI recently, which "helped for three days." She's out of both the Duragesic and Hydrocodone and he won't give her any more until next week, so she thought she'd try and see if I'd take it over. She refuses PT, won't exercise, cried the whole H&P today, hurts everywhere and with every movment on exam. And she's diabetic with a recent HgbA1c of 8.9. :thumbup:

    I gave her Cymbalta.
     
  5. ampaphb

    ampaphb Interventional Spine

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    I'm not sure I would have even done that!

    Sounds like a perfect candidate for a psych referral (terribly sorry, Ms. X, your case is simply beyond my abilities. I am not in anyway implying you are crazy, or that your pain is all in your head, but clearly there are issues that I think would be helpful for you to discuss with a professional, and I believe Dr. Y, with his warm, understanding, holistic approach, would be the perfect physician to take the time to sit down with you and try to work through you concerns more thoroughly than I can)

    PUNT!
     
  6. spondy14

    spondy14 Attending

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    I would give her the boot
     
  7. Tenesma

    Tenesma Senior Member

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    it is soooo good to know that i am not the only one seeing these patients....
     
  8. lobelsteve

    lobelsteve SDN Lifetime Donor
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    41 y/o WM from 4 hours away for NP appt today. Brings in Methadone in Rx bottles from 2 different pharmacies and 2 different Docs. Also has an Rx bottle for 30mg Oxycodone q6h from a third pharmacy. At least the bottles were not empty. RN said he smelled like alcohol. I did not go in the room- I sent in the nurse to tell him I'd be happy to see him and charge $275 for the visit (self pay of course), but under no circumstances would I be taking a risk on an out of state self pay 41 y/o male who smells like alcohol as far as writing narcotics goes. He understood enough to know I ain't the candyman and left without being seen. There are two pain clinics within 500 yards of my office.
     
  9. 2win

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    To Da Moon! That's The Spirit!
     
  10. Doctodd

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    awwww....you should have seen him and then said you wouldnt prescribe after billing him or collecting the fee. Im sure he already knew the risk and he took up a slot in your schedule. Im sure he knows the drill.

    T
     
  11. Gauss

    Gauss Damnit Jim!

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    I've had poor outcomes with cymbalta. Many of my patients get over-stimulated from it, insomnia, hypo-mania, tremors, agitation. Mediocre antidepressant as well. Usually don't see the somnolence side effect often.
     
  12. Tenesma

    Tenesma Senior Member

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    there is this growing trend amongst Cymbalta patients where they come back after 5 or 6 months of success with it, then stating it is no longer effective or that new side-effects are popping up - they stop it, the side-effects disappear...

    hmmm...
     
  13. Mister Mxyzptlk

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    Why can't they approve it for any neuropathic pain instead of just DPN? The schmucks at the PBMs who hide behind the PDR will deny it for neuropathic pain unless it's due to diabetes.

    Instead they are chasing the dime and climbing on board the FMS train.
     
  14. Gauss

    Gauss Damnit Jim!

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    getting approval for lyrica and/or cymbalta for neuropathic pain is the bane of my clinic. So many treatment auth requests and so many denials.
     

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