Cymbalta For Back Pain

Eli Lilly gets credit for being economically savvy and the first out of the chute.

Cymbalta (duloxetine) is a much awaited antidepressant that is supposed to be effective especially on the bodily aspects of depression.  Those pesky aches and pains that are associated with depression in one form or another.

They seem to have secured “back pain” as an indication for Cymbalta.

The correlation of back pain with depression is a part of intuitive clinical knowledge that has been around for a while.  A good thing, since people have been studying back pain for well over 150 years and have never agreed on what physical structure causes the pain.

This is an area where academics seem to have fumbled — except for one.

As far as I am concerned, Dr. John Sarno — who described “tension mysositis syndrome” and who wrote the book and sells written and videotaped materials about back pain — owns the field.  I respect people who are capable of observation.  Some people who practice medicine for 30 years live the same thing over and over again with every patient they see.  Kind of like the movie “Groundhog Day.”

But people often forget that the ground zero of science is not simply planning experiments and getting grants.  It starts — when it is at its best — with original ideas. Dr. Sarno, a physiatrist, watched his back pain patients, including those who had multiple operations and lots of problems, and noticed some things.

He noticed what didn’t work — things like physical treatments, in plenty of cases.  On one of his tapes he says physical therapy is of no help whatsoever. Often, surgery is of no help and makes things worse.

In my former life as a neurosurgeon, I did plenty of these interventions on necks and backs – what the medical insiders call “chicken surgery” – and so I knew exactly what Dr. Sarno was talking about. Now I am NOT talking about a fragment of a disc slipped into a nerve sheath. There definitely are some constituted lesions that are mechanical and need fixing.

But all you have to do is hang around with back pain and sciatica patients long enough and even the doctors with the most anti-psychiatric bias – surgeons — have been known to say there is “something psychological going on.

Dr. Sarno’s tension myositis syndrome is basically the muscles at the back of your neck getting tight enough to compromise the arterial circulation to the back muscles — which don’t get enough oxygen — so they hurt.

Now that I’m a psychiatrist, most of the people I meet with back pain are also being treated for depression.  As I look back, there was only one time in my career when I had really bad back pain – thank God.  As a matter of fact, I once had a left L5 (5th lumbar ) radiculopathy. I was still doing chicken surgery at the time — clearly the wrong profession for moi.  I had a massage and a change of profession, and have never again been bothered with back pain so severe that it actually laid me up for a couple of days off work.  Not ever.  In case you have not noticed, I now have this work that I really love.

Sarno said that the back hurt when the subconscious was poking through to the conscious.  A little journaling, an acceptance of the idea and effort to understand oneself was all it really took.  If someone could not hack it on their own, they could talk to a psychoanalyst.

Now we have EFT — or “tapping” – of which I am an enthusiastic practitioner.  No drugs involved, no injections, no surgery, and yet it is wildly effective in cases where there is no specific injury. I do not think Cymbalta necessarily any better for back pain than any other antidepressant.  The company just took the initiative and spent the money to get FDA approval for an additional indication. They must be doing some pretty good publicity at Eli Lilly, for only a day or two ago a patient wanted to change to that antidepressant in order to fix her back.  I convinced her to just crank up the dose of what she was on, and try it for a while first.

Publicity rarely reflects truth, so we must learn to tell the difference.