I don't know if this helps or not. My Cymbalta was approved by the insurance company, but I'm already in high doses of so many other generic drugs, like Amitryptiline, Gabapentin, Amantadine, and I'm also already on Depakote. I don't know if they'll approve me when I have to get to the higher dosage for Cymbalta to work for the pain. I think the best way is for you to talk to your MD and/or his NP, and discuss about the reason they think you should be on either drug or both drugs, if necessary. The approval really based on the "letter" from your MD and your records that the insurance has. there has to be a strong reason why the insurance company has to pay for really expensive drugs like Cymbalta.

Since it is very expensive, unless it's really necessary I wouldn't pay for it - but that is me. I pay Zyrtec from my own pocket because the insurance wouldn't cover and I really allergic to many things and I have not found a satisfying alternative. If I found that it works, and insurance company only approved for the small dosage, I probably will pay for the remaining dosage - only IF it works very well for my pain.

The other thing about Cymbalta is it is relatively new. It is only approved for depression and diabetic neuropathic pain. So you kind of gambling the long term effect more than the scenario that use the alternative to Cymbalta.

What was the reason that your MD wants to discontinue the Topamax?
Have you ever been on Neurontin (Gabapentin)? Now the generic is available, and it also contains anti-depressant effect though not much. Have you been on Amitriptyline? It works a MIRACLE for the pain. And I'm sure your insurance company will approve, even on very high doses (I'm taking 150mh HS) And, it has strong anti-depressant property.

hope you'll feel better soon..

p.s. I just noticed your second message. Every night I look at the mouthful of drugs I have to take. Well.. different persons react differently to the drugs. Some just have allergic reaction to almost anything, but some like me, could tolerate drugs very well. Each of us is made differently, and sometimes we forgot that. But even I have to take a month or two to be "free" of unpleasant side effects and get the maximum effects of the drugs. I think you have to ask yourself why you go to the doctor in the first place. I hate doctors who just order me things.. I love doctors that always include me in decision making. But it makes no sense for you to go all that hasle, making appointment, getting to the hospital etc., if you would just contemplate the prescriptions in front ot you. If you really2 have problem (phobia) with it, probably u should see a psychologists. They could help you to overcome your phobia.