A New Approach for Low Back Pain?

Many studies have been done, and the present best answer for low back pain is to keep active (walking is probably best), and take an NSAID (ibuprophen = Advil® or acetaminophen = Tylenol®).  But what to do if the pain becomes chronic and there’s no evidence of a severe disc or nerve problem?  A new approach is to take an antidepressant, according to the FDA, which has just approved duloxetine (Cymbalta®) for this indication.

Cymbalta is already approved for 4 indications:  depression, generalized anxiety disorder, diabetic nerve pain, and fibromyalgia.  The FDA based its approval for the use of the drug in chronic musculoskeletal pain in patients with chronic low back pain and chronic pain due to osteoarthritis.  More than 600 patients were treated in 4 double-blind, placebo-controlled, randomized clinical trials.  Those taking Cymbalta had a greater reduction in their pain scores than those taking placebo. 

The safety database for the drug is large – nearly 30,000 patients have taken Cymbalta in clinical trials that have monitored side effects.  The most common side effects reported include nausea, dry mouth, insomnia, drowsiness, constipation, fatigue, and dizziness.  Serious side effects are very rare, being reported in less than 1% of patients on the drug; they include liver damage, allergic reactions, pneumonia, depressed mood, and suicidal thoughts and behavior.

The large number of different treatments for chronic low back pain shows that none of them is very good; Cymbalta offers another, which may help until a specific, effective agent comes along.