Treating Fibromyalgia-Related Neck Pain with SNRIs

cymbalta savella neck pain fibromyalgia treatment

Is Cymbalta overprescribed for neck pain and other fibromyalgia symptoms?

Cymbalta and Savella offer only a small degree of pain relief for those suffering from fibromyalgia, according to a new meta-analysis. The Cochrane review’s authors suggest that advertisements for the drugs that show women becoming free of fibromyalgia symptoms are misleading and that physicians need to discuss realistic expectations with their patients. More than five million Americans are thought to suffer from fibromyalgia, with around 80% of patients women and many receiving one of these selective serotonin and noradrenaline reuptake inhibitors (SNRIs)as treatment.

‘Number Needed to Treat’ for Fibromyalgia Medication Success Same as for Adverse Reactions

Using SNRIs for fibromyalgia pain, which can include neck pain, is now fairly commonplace but this Cochrane review may lead physicians to reconsider prescribing such drugs as the benefits appear minimal. This review concluded that eleven people need to be treated for just one to have a good outcome, figures mirrored by the number of people needed to be treated for an adverse event to occur. Higher doses of the drugs were not found to have a more significant effects but did increase the risks of adverse reactions and people stopping taking the drugs.

Side-Effects of Cymbalta and Savella

Duloxetine and milnacipran (sold under the brand names Cymbalta and Savella) are known to have a number of adverse effects, including nausea, dry mouth, constipation, headache, dizziness and insomnia. As these drugs were found to offer only minor relief in terms of fatigue and sleep problems in patients with fibromyalgia the evidence suggests that they are overused and that physicians rely on them too much when treating patients with fibromyalgia. The slight pain relief that patients do get may also only be temporary and improvements in quality of life for those with fibromyalgia syndrome appear limited with such drugs.

Cymbalta and Savella Give Little Relief for Fibromyalgia Pain

The author of this new study, Brian T. Walitt, MD, associate professor, medicine, Georgetown University, Washington, DC, noted that fibromyalgia is more than just a pain syndrome and that the value of Cymbalta and Savella for fibromyalgia is small when looking at all the symptoms of this condition and how these medications help patients. It may be that patients are better served by having non-pharmaceutical treatment for fibromyalgia, such as cognitive behavioural therapy, but the evidence supporting (or criticising) these kinds of interventions is still minimal, making decisions over treatment difficult.

SNRIs Little Better than Placebo

This new Cochrane review looked at ten studies, amounting to over six thousand patients, half of which observed patients taking either placebo or milnacipran and the other comparing placebo to duloxetine over a period of six months. Most of the patients were women and most fell between the ages of 47 and 51, making the conclusions difficult to extend to other patient groups. The review found that there was a small pain reduction for both duloxetine and milnacipran but almost as many patients in the placebo group reported a 50% pain reduction as in the treatment groups.

Lyrica, Cymbalta and Savella

Of the two drugs for fibromyalgia, duloxetine appeared to offer better pain relief but relief of fatigue and improvements in quality of life were insignificant compared to placebo. Neither drug helped more than placebo with patients’ sleep problems and although duloxetine and milnacipran are approved for use in the US, neither have been approved in Europe. Pregabalin (Lyrica) is also approved by the US Food and Drug Administration but there have been a number of reported side-effects since its approval.

Causes of Fibromyalgia

One promising avenue of fibromyalgia research is in the area of small fiber polyneuropathy, with a recent study finding around half of all patients diagnosed with fibromyalgia were suffering from this potentially treatable nerve condition. Understanding the neuroanatomical basis of the syndrome appears key to finding appropriate treatments, but this will take time and patients have little to fall back on in the interim.

“The truth is that nothing really works.”

The study’s author, Walitt, said of fibromyalgia symptoms: “These problems don’t go away. The truth is that nothing really works.” Instead of relying on drugs, he suggests that patients with fibromyalgia do best when they accept their condition and the limitations it places on their life and get on with things as well as they can. Of course, prescribing stoicism makes pharmaceutial companies no money and these drugs do offer some patients some pain relief at least so it is unlikely that patients taking Cymbalta or Savella for fibromyalgia symptoms such as neck pain will stop being prescribed the drugs to relieve that pain.


Cochrane Library. 2013, Issue 1. Abstract

If you enjoyed this post make sure you’re the first to see future updates by liking the Facebook page!

611 replies
  1. says:

    I’m not sure why but this web site is loading incredibly slow for me.
    Is anyone else having this problem or is it a problem on my end?
    I’ll check back later and see if the problem still exists.

  2. says:

    Undeniably believe that which you stated. Your favorite justification appeared to be on the web the simplest
    thing to be aware of. I say to you, I certainly get annoyed while people think about worries that they just do not
    know about. You managed to hit the nail upon the top and defined out the whole thing without having side-effects , people could take a signal.
    Will probably be back to get more. Thanks

  3. says:

    I’ve learn some good stuff here. Certainly value bookmarking for revisiting.
    I surprise how so much attempt you put to create this kind of wonderful informative website.

  4. says:

    Do you mind if I quote a few of your posts as
    long as I provide credit and sources back
    to your site? My website is in the exact same niche as yours
    and my users would certainly benefit from some of
    the information you provide here. Please let me know if this okay with you.
    Thanks a lot!

  5. says:

    It’s appropriate time to make some plans for the long run and
    it is time to be happy. I’ve learn this post and if I could I wish to counsel
    you few attention-grabbing things or suggestions.

    Maybe you can write subsequent articles referring to this article.
    I desire to learn more issues approximately it!

  6. says:

    Heya i am for the first time here. I came across this board and I find It truly useful
    & it helped me out a lot. I am hoping to provide one thing back and aid others such as you aided me.

  7. says:

    Whoa! This blog looks exactly like my old one! It’s on a entirely different subject but it has pretty much the same page layout and design. Excellent
    choice of colors!

  8. says:

    Have you ever considered publishing an ebook or guest authoring on other blogs?
    I have a blog based upon on the same ideas you discuss and
    would love to have you share some stories/information. I know my visitors would value your work.
    If you are even remotely interested, feel free to send me an email.