Tramadol on its own may be a better choice for nerve pain as it does alot of what the cymbalta does as well as some of what the vicodin does. However as you are on cymbalta, you would be better off with the vicodin as cymbalta and tramadol can have an interaction problem. Tylenol is basically useless for nerve pain, and for most pain outside of a mild headache etc..., and can be hard on your liver especially as you are getting 500mg of tylenol in each vicodin as well. lidocaine in a local anesthetic, and it will only help with pain at the exact site you place the patch; it has no centrally acting properties. Your best bets are to stick with the cymbalta, and get the dose to a good dose for pain (60-120 mg/day), and use vicodin for breakthrough pain as needed, but not on a regular basis.