Very interesting! I was recently prescribed Cymbalta as well for chronic pain in my first rib area [0], but until reading your post had some remaining skepticism about going through with it.
In my case, chronic pain seems to be affecting my sympathetic nervous system and causing dysautonomia, manifesting as delayed orthostatic hypotension (blood pressure drops after a few minutes of standing) and compensatory orthostatic tachycardia (heart rate increases to compensate), similar to POTS (postural orthostatic tachycardia syndrom, which, strictly speaking, is just the heart rate symptom and not the blood pressure one).
My doctor who prescribed the Cymbalta described the approach as "multi-modal", since I'll be getting a treatment of pulsed radiofrequency neuromodulation to the painful area (the first rib area) to numb the pain up. But I already have widespread chronic pain, which seems to relate to my POTS (the spine has nerves close enough to the first rib that pain signals could be spilling over and affecting the sympathetic fibers regulating the autonomic nervous system, i.e., things like heart rate and blood pressure). This gives me hope that if my doctor is right, something like Cymbalta could work in tandem with numbing up the pain locally to turn these pain signals down a notch, and hopefully do something to ease up the POTS over time.
In my case, chronic pain seems to be affecting my sympathetic nervous system and causing dysautonomia, manifesting as delayed orthostatic hypotension (blood pressure drops after a few minutes of standing) and compensatory orthostatic tachycardia (heart rate increases to compensate), similar to POTS (postural orthostatic tachycardia syndrom, which, strictly speaking, is just the heart rate symptom and not the blood pressure one).
My doctor who prescribed the Cymbalta described the approach as "multi-modal", since I'll be getting a treatment of pulsed radiofrequency neuromodulation to the painful area (the first rib area) to numb the pain up. But I already have widespread chronic pain, which seems to relate to my POTS (the spine has nerves close enough to the first rib that pain signals could be spilling over and affecting the sympathetic fibers regulating the autonomic nervous system, i.e., things like heart rate and blood pressure). This gives me hope that if my doctor is right, something like Cymbalta could work in tandem with numbing up the pain locally to turn these pain signals down a notch, and hopefully do something to ease up the POTS over time.
[0] https://news.ycombinator.com/item?id=24949553