Most antidepressants prescribed for chronic pain lack reliable safety and efficacy evidence

Most antidepressants used for chronic pain are being prescribed with "insufficient" evidence of their effectiveness, scientists have warned. A major investigation into medications used to manage long-term pain found that harms of many of the commonly recommended drugs have not been well studied.

The Cochrane review, led by scientists from several UK universities including Southampton and Newcastle, examined 176 trials consisting of nearly 30,000 patients involved in assessments which prescribed antidepressants for chronic pain.

Among the drugs studied were amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine - with only the latter showing reliable evidence for pain relief.

The two-year Cochrane study was the largest ever assessment of antidepressants recommended by leading bodies including the UK’s National Institute for Health and Care Excellence (NICE) and the Food and Drug Administration (FDA) in the USA.

The review revealed that duloxetine was consistently the highest-rated medication and was equally as effective for fibromyalgia, musculoskeletal, and neuropathic pain conditions.

Other results showed:

• Standard doses of duloxetine are as successful for reducing pain as higher quantities,

• Milnacipran was also effective at reducing pain, but scientists are not as confident as duloxetine due to fewer studies with fewer people.

Reference:

Antidepressants for pain management in adults with chronic pain: a network meta-analysis,Cochrane Database of Systematic Reviews, DOI 10.1002/14651858