Duloxetine is a prescription-only drug used to treat depression. However, we also use Duloxetine for chronic pain, including musculoskeletal pain such as osteoarthritis. What is the evidence for using Duloxetine for osteoarthritis and chronic pain, and how should we use it?

How does Duloxetine work for pain?  

Duloxetine is a selective serotonin and noradrenaline reuptake inhibitor. This means that the levels of these hormones – serotonin and noradrenaline increase, which produces pain-relieving effects. This positive effect is focused on the pain-producing nerves in your body. 

What conditions are treated effectively with Duloxetine? 

Duloxetine was marketed as an anti-depressant medication due to its positive effects on major depression and anxiety. Subsequently, we discovered it was effective in pain states such as nerve pain and fibromyalgia. Moreover, Duloxetine is helpful for musculoskeletal conditions such as knee osteoarthritis and lower back pain.

Duloxetine for osteoarthritis and musculoskeletal pain: what is the evidence? 

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Recent studies have shown that Duloxetine improves pain associated with musculoskeletal conditions such as chronic low back pain, knee osteoarthritis, fibromyalgia and neuropathic (nerve pain). 

A recent review found that Duloxetine is effective for chronic low back pain and osteoarthritis. The optimal dose for effectiveness was 60mg/ day. Moreover, increasing the dose to 120mg/day was associated with increased side effects without further improvement in symptoms.

When compared to other nerve drugs such as Amitriptyline, pregabalin, or gabapentin, Duloxetine was more effective with a similar or less side effect profile.

Another study found that Duloxetine was effective for knee but not hip osteoarthritis.

Duloxetine does not treat the underlying inflammation but reduces pain sensation. Therefore, for a more significant effect, you can take other anti-inflammatory medications, such as ibuprofen or Celebrex, with Duloxetine.

Side effects 

Like all medications, Duloxetine has side effects, some more common than others.

More common side effects are gastrointestinal, such as nausea, dry mouth, reduced appetite, and constipation. Also, Duloxetine may make you anxious or sleepy when taken.

Less common side effects include headaches, dizziness, tiredness, diminished sexual function and muscle pain or cramping.

Nonetheless, these side effects are generally mild and will settle within a few days of taking the medication.

Possible interactions

Particular medication may increase or decrease the effect of Duloxetine. You should speak to your doctor if you are taking any of the following medications:

  • Blood thinners such as Warfarin or aspirin
  • Quinolone medication, including ciprofloxacin
  • Pain medication such as codeine or morphine

Also, you should limit the alcohol you consume. Studies show consuming alcohol with Duloxetine can increase liver damage.

How to take Duloxetine for osteoarthritis and other pain conditions 

Duloxetine comes as a delayed-release capsule. We usually start with a 30mg capsule in the morning., but we may increase the dose to 60mg if needed.

You should avoid chewing, crushing, or opening the capsule. We advise taking it with food to prevent a stomach upset.

Other commonly asked questions about Duloxetine for osteoarthritis: 

How long does Cymbalta take to work? 

Like all other nerve drugs, the effect of Duloxetine (or Cymbalta) doesn’t start immediately. Often, people benefit after 2-4 weeks.

How long can you take Duloxetine for nerve pain? 

Generally, we recommend taking Duloxetine for 3-6 months to treat nerve pain. However, if you think it’s effective, you can sometimes take it longer. 

Celebrex vs Duloxetine: which is better? 

Celebrex is an NSAID – a class of drugs that reduces inflammation. It is best used as an anti-inflammatory. On the other hand, Duloxetine minimises the sensitivity of the pain nerves and takes a few weeks to start working. Both medications can be used together to treat musculoskeletal pain.

Can you drink alcohol with Duloxetine? 

Generally, we suggest you limit or stop alcohol while taking Duloxetine. Combining the two may lead to increased liver damage.

Can you stop Duloxetine suddenly? 

We generally advise against stopping suddenly. If you stop this drug suddenly, you may experience withdrawal side effects such as dizziness, nausea, headache, and tiredness. It would be best if you spoke to your doctor about how to stop this drug. 

Can I take Tylenol with Cymbalta? 

Yes. Tylenol is also known as paracetamol. Although they reduce pain through different mechanisms, Tylenol and Cymbalta work together. So, it is entirely safe to take them together. 

Can you combine Duoxetine with a knee joint injection for knee arthritis? 

Yes. A recent study found that combining Duxoxetine with a knee injection (cortisone and hyaluronic acid) was more effective than the injeciton alone. 

Final word from Sportdoctorlondon about Duloxetine for osteoarthritis and musculoskeletal pain

Duloxetine is used to treat chronic musculoskeletal conditions such as chronic low back pain, nerve pain, and knee osteoarthritis. It is generally well tolerated, although you should speak to your doctor about adding It to your treatment regimen.

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