Cymbalta (duloxetine) vs Amitryptyline?

Hi Everyone-

I have posted here before about having acquired a trigeminal pain following a perfect storm of a facial filler injection and what was an unrecognized deep upper molar infection that led to the extraction of that tooth. Pain all concentrated in the upper cheek (continuous mild burning and tight pain that completely vanishes at night when asleep) and now at the site of the extraction. Lots of visits to different doctors - some knowledgeable and some not and a perfectly clear MRI(no compression) Finally found a neurologist who although doesn’t specialize in trigeminal neuralgia does treat it and diagnosed me with trigeminal neuropathy or hypersensitivity caused by trauma with a strong chance of healing over time. I wholeheartedly agree with him that I don’t have classic TN and maybe closer to ATN but his diagnosis made sense to me. He put me on gabapentin which unfortunately did nothing after 2 weeks of 900 mg a day and i was having too many side effects to up the dosage. In the meantime I have also seen a top facial pain specialist in Chicago (Dr Sahni recommended by someone on this site) who agreed with neurologist’s diagnosis but was disappointed to hear gabapentin wasn’t working as that is what she would have prescribed too. Her second option for me was Cymbalta (since I also have anxiety) and she has seen success with it for nerve pain. This is where the fun begins. Since I was going to follow up with my neurologist anyway I mentioned the facial pain specialist visit and he said he has never had a patient for whom Cymbalta worked and that his recommendation is low dose of Amitryptyline. Who does one believe here? I think highly of both of these providers so hoping someone here with similar diagnosis can shed some light on what might be a more effective medication for me to try. I am hoping not to have to continue starting new meds all the time and getting on Cymbalta means getting off Paxil which I take for anxiety since the two together can cause serotonin syndrome. I am at this stage assuming I can remain on Paxil while taking a small dose of Amitryptyline but will verify with neuro when I talk to him next week. Any insight would be really appreciated. Also for what it is worth while gabapentin was useless clonazepam which I occasionally take for anxiety either completely eliminates or reduces the pain. That said neither provider was comfortable with me taking a benzo daily due to addiction potential.

I’ve had ATYPICAL neuralgia for sixteen years as of 1-21.
I’ve taken all the meds you’ve taken, over the years, & in the same succession.
Amitriptyline is /has worked for me for the last six years of my life…
Plus, the pain and numbness lessened over time.
I’ve evolved into a “new normal “…
And it works for me!:grin:
I wish you positive thoughts, & positive results!

Doctors practice Medicine.
Some Docs use a medication off label and find it works for that malady.
Others refuse, for legal reasons, to ever use a Medication off label.
I just saw an Orthopedist for a torn muscle —he injected a steroid to treat it.
Another Ortho, seeing me for a different problem, said he had never heard of doing that BUT that the first doc had been around a long time so it must have been working for him.

Both specialists may be right, as both Duloxetine and Amitriptyline are psychotropic Rx and both are used for pain.

Duloxetine is used more for peripheral neuropathy (diabetic & chemotherapy caused; small fibre neuropathy) - haven’t seen it used for facial neuropathic pain, but that doesn’t mean it’s not worth trying. It might treat the anxiety and the pain. Yes, you’d have to switch off the SSRI you are on.

Amitriptyline is an older Rx, a “tricyclic antidepressant”, long used in pain management at low or relatively low doses. There are potential moderate interactions with Paroxetine (Paxil) and Amitriptyline - "In general, the use of paroxetine (or other SSRIs) with TCAs should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk… " (Source: Drug Interaction Report - Keep in mind though that you’d be on LOW doses of Amitrip.

There are similarly “moderate” interactions between gabapentin and the SSRI you are on. But same also goes for Alcohol and Paxil!
Moderate interactions do not mean not to use them in combo, but to use with caution, watch for side effects, sometimes do blood test monitoring, etc.

Sounds like low dose Amitrip might be worth trying, and if not helpful, then you can still try switching off of the SSRI and trying Cymbalta. But you might first try other Rx, like e.g. pregabalin.

Your usual neurologist will be managing you long term, so may be best to work with them and your family doctor.

Finally: There is no ONE Rx that is better than another for facial pain. Each person and the pain they experience and the response to Rx is different.

One last suggestions is to find a Mindfulness-Based Cognitive Therapy (MBCT) course (many are online these days) as it is an evidence-based non-pharmacologic therapy for anxiety AND pain.

Hope this helps.
(p.s. I am an MD, MBCT teacher, and facial pain patient; the above info is intended as information only, not advice)

I have had atypical neuralgia for 7 years following sinus surgery. I have tried both amitriptyline and gabapentin. The only medication that has helped is pregabalin. I hope you find relief soon.

I’m wondering why they didn’t suggest an anti-convulsant? Aren’t those the first choice for trigeminal neuralgia? I have taken Tegretol and Trileptal - both worked 100% but the Trileptal had far less side effects.
I hope you find something that works for you, everyone responds differently.

i don’t have TN - I have trigeminal neuropathy

I have a very similar condition to you with atypical facial pain focused in one part only of my left cheekbone. Gabopentin did not work for me either and then my neurologist suggested Cymbalta which she said would help with the anxiety I had developed due to this condition as well as work on the nerve pain.

I had to go off Wellbutrin which I had been on for years but frankly I was more anxious than depressed at this point. I am happy to report that the Cymbalta has gotten rid of almost all the pain. In fact most days I am pain free. I am on 60 mg once per day. The first few weeks were tough as I had no appetite at all which is especially hard as I am a slender woman. But that side effect went away, and I can honestly say I feel healthy and strong again. I have spoken to several people at the facial pain association and many are on Cymbalta. Lyrica is often used as well but it can cause significant edema and weight gain from users I have spoken with recently. But everyone is different- so you do need to find what is right for you.

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I’ve had bilateral ATN for over 22 years and have found little or no relief from most medications. I’m not a candidate for any procedure or surgery. That being said I have had a modicum of relief with clonazepam. Doing cognitive therapy such as breathing exercises helps as does distractive activities (if the pain isn’t too bad). I’m a firm believer in the power of prayer and find the comfort I receive from knowing that God is in control and is actively working for my good helps me to relax more.
:blush: Sharon


I have what I call neurofibromatosis-induced trigeminal neuralgia, because I have had several neurofibroma’s appear on my nerves, some of the most prominent being the trigeminal. As the tumors have grown, been cut out, and come back again, I’ve had a bit of pain.

I have tried lots, as many others here have, and am currently managing my pain with a combination of Cymbalta and Lyrica. This is what I have found to be the most effective and with the least side effects (fatigue being the most prominent).

When I was initially on Cymbalta, but I moved and my new doctor convinced me to switch to amitryptyline. I felt miserable all the time and had zero energy or motivation, and I was still in significant pain. I found everything to be a drag, and after 6 months when I still felt that way, I convinced him to put me back on Cymbalta.

I still have pain, but it is much decreased. Going back on also helped my sleep.

As others have duly noted though, every person is different. And you MUST give these meds time to kick in and for your body to adjust before you can rule them out.

I hope you have found solace in our community, and I hope you have respite from pain soon!

You sound exactly like me when it comes to sleeping, if I could I would sleep all day everyday .In the beginning lamictal worked the best for me .Presently I am on amitriptyline, gabapentin, botox q3months for chronic migraine disorder, savella for fibromyalgia, xampta q 12 hrs and endocet for break through pain ,and xanax.In 2019 I couldn’t stand the pain anymore, I was 11 years in at that point ,we’ll for me that is a no go ,It’s not working and it sticks out of my face next to my r side of nostril Luke a huge whitehead ,can you imagine as I get older ,skin thins ,it’s gonna pop right through my face ,by then he’ll be retired .I have heard good things about the trigeminal branch stimulator, what works for 1 doesn’t necessarily work for others ,good luck fellow warrior, I have heard of Cymbalta working for some people. Amytriptaline use to give me a smidge of relief, now I don’t feel the meds are working that well ,but my Neurologist won’t change them ,only to lower them …If I ask for the higher dosage again, she won’t give it to me …