Lack of effectiveness of antidepressants used increasingly for chronic pain, finds study

New research has found some antidepressants may be effective in treating certain chronic pain conditions, but others lack convincing evidence on their effectiveness. An international team of researchers, has found that some classes of antidepressants were effective in treating certain pain conditions in adults, but others were either not effective, or the effectiveness was unknown. The researchers say the results show that clinicians need to consider all the evidence before deciding to prescribe antidepressants for chronic pain management.

Antidepressants may have unpleasant side effects that patients may wish to avoid. The review examined 26 systematic reviews from 2012 to 2022 involving over 25,000 participants. This included data from eight antidepressant classes and 22 pain conditions. Serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants such as duloxetine were found to be effective for the largest number of pain conditions, such as back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and neuropathic pain (nerve pain).

By contrast, tricyclic antidepressants, such as amitriptyline, are the most commonly used antidepressant to treat pain in clinical practice, but the review showed that it is unclear how well they work, or whether they work at all for most pain conditions. This review distilled the evidence from over 150 clinical trials into an accessible summary that clinicians can use to help them make better decisions for their patients with chronic pain.

Reference:

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews,BMJ,DOI: https://doi.org/10.1136/bmj-2022-072415.