Back Pain (cont.)
IN THIS ARTICLE
When to Seek Medical Care
The Agency for Healthcare Research and Quality has identified 11 "red flags" that doctors should look for when evaluating a person with back pain. The focus of these red flags is to detect fractures (broken bones), infections, or tumors of the spine. Presence of any of the following "red flags" with low back pain should prompt a visit to your doctor as soon as possible for complete evaluation.
- Recent significant trauma such as a fall from a
height, motor vehicle accident, or similar incident
- Recent mild trauma in those older than 50: A fall down a few steps or slipping and landing on the buttocks may be considered mild trauma.
- History of prolonged steroid use: People with asthma, COPD, and rheumatologic disorders are frequently on this type of medication.
- Anyone with a history of osteoporosis: An elderly woman with a history of a hip fracture, for example, would be considered high risk.
- Any person older than 70: There is an increased
incidence of cancer, infections,
and abdominal causes of the pain.
- Prior history of cancer
- History of a recent infection
- Temperature over 100° F
- IV drug use: Such behavior markedly increases risk of an infectious cause.
- Low back pain worse at rest: This is thought to be
associated with an infectious or malignant cause of pain.
- Unexplained weight loss
- The presence of any acute nerve dysfunction should
also prompt an immediate visit. These would include inability to walk or
inability to raise or lower your foot at the ankle. Also included would be the
inability to raise the big toe upward or walk on your heels or stand on your
toes. These might indicate an acute nerve injury or compression. Under certain circumstances, this may be an acute neurosurgical emergency.
- Loss of bowel or bladder control including difficulty
starting or stopping a stream of urine or incontinence can be a sign of an acute emergency and requires urgent evaluation in an emergency department.
- If you cannot manage the pain using the medicine you are currently prescribed, this may be an indication to go to an emergency department. Generally, this problem is best addressed with the doctor writing the prescription who is following you for this problem.
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Cymbalta is approved for the treatment of fibromyalgia.
Important Safety Information
Cymbalta® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.
What should I talk about with my healthcare provider?
Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.
You should also know that:
- ·Suicide is a known risk of depression and some other psychiatric disorders.
- ·Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
- ·All patients starting therapy should be monitoblue appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
- ·Cymbalta® is not approved for use in patients under age 18.
Who should NOT take Cymbalta?
You should not take Cymbalta if:
- ·You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
- ·You have uncontrolled narrow-angle glaucoma (an eye disease)
- ·You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:
- ·about all of your medical conditions, including kidney problems, glaucoma, or diabetes
- ·about your alcohol use
- ·if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
- ·if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
- ·if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant
While taking Cymbalta, tell your healthcare provider:
- ·if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
- ·if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
- ·before stopping Cymbalta or changing your dose
- ·if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta
If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?
The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.
Read What Your Physician is Reading on eMedicine
Back Pain, Mechanical »
Mechanical low back pain is one of the most common patient complaints expressed to emergency physicians in the United States accounting for more than 6 million cases annually.
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