Direct Treatment Effect With Cymbalta
According to data coming out of four separate clinical trials, patients who suffer from both depression and fibromyalgia experience significant improvement for the two conditions when they are treated with duloxetine (Cymbalta). The pooled data from these trials were presented in San Antonio, Texas, at a meeting of the American Academy of Pain. It seems that Cymbalta relieves pain in the same measure no matter the severity of the level of the patient's depression, while mood improves no matter the severity level of the patient's pain.
An analysis of the data from these trials showed that the medication yielded both direct and indirect benefits in pain and mood improvement. The data suggests that the direct benefit of the drug is between 60%-70% while the indirect benefit makes up the remaining 30%-40% of the apparent improvement in pain and mood. Lauren B. Marangell MD, of the Indianapolis-based Eli Lilly &Co. and her colleagues, made a presentation in poster form at the meeting which stated, "Improvement in pain and improvement in major depressive disorder are positively correlated. Improvement in pain reflected greater direct treatment effect with an indirect effect of improved mood, indicating that the improvement seen with duloxetine in fibromyalgia is not solely a mood effect."
The presentation emphasized that mood improvement was discovered to reflect the greater, more direct effect of the treatment, while pain improvement was found to be an indirect benefit of the drug therapy. The researchers stated in their presentation that these findings show that duloxetine can have an independent benefit in treating the pain of fibromyalgia, even where depression is not co-morbid.
Up to a third of all fibromyalgia patients suffer from major depression, as well, while 70% of all fibromyalgia patients have a history for major depression. Trying to figure out how these two conditions fit in with each other gets muddled because pain tends to shout its presence, which serves to obscure the depression. This can lead to undiagnosed, co-morbid depression, which in turn may mean that the depression part of the equation goes untreated.
To confuse matters further, major depression can worsen in response to the way that pain gets in the way of everyday activities. That means that worsening depression leads to an increase in reports of pain with the pain increasing in intensity and in duration in those patients afflicted with fibromyalgia.