Are antidepressants for chronic pain effective?

Antidepressant drugs may not improve long-term quality of life

New research has revealed that antidepressants may be effective in treating certain chronic pain conditions, but there is a lack of evidence on their effectiveness.

Chronic pain affects between one-third and one-half of the UK population. The treatment of chronic pain is often suboptimal, with commonly used medicines having limited or unknown benefits and sometimes harmful side effects. Antidepressants are now being prescribed to treat certain chronic pain conditions.

Now, an international team of researchers, including researchers from the University of Warwick, have investigated the effectiveness of antidepressants for treating chronic pain. The study is published in The BMJ.

Are all antidepressants effective at treating chronic pain?

The study reviewed the safety and effectiveness of antidepressants in the treatment of chronic pain, and for the first time, it brings together all the existing evidence in one document.

Professor Martin Underwood from the University of Warwick, a co-author of the paper, said: “There is a role for antidepressants in helping people living with chronic pain, however, this is more limited than previously thought.

Antidepressants may have unpleasant side effects that patients may wish to avoid.

We need to work harder to help people manage their pain and live better without relying on the prescription pad.”

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, including back pain, fibromyalgia, headaches, postoperative pain, and irritable bowel syndrome. Serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants such as duloxetine have previously been shown to be effective for treating a large number of pain conditions, such as back pain.

Contrastingly, tricyclic antidepressants, such as amitriptyline, are the most commonly used antidepressant to treat pain in clinical practice; however, the review highlighted how unclear how well they work or whether they work at all for most pain conditions.

The growing need for chronic pain interventions

The use of antidepressants for chronic pain has grown significantly over the last few years. The 2021 guideline for chronic primary pain management published by The National Institute for Health and Care Excellence (NICE) has recommended against using pain medicines except for antidepressants. Within the guideline, different types of antidepressants, such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline, are recommended for adults living with chronic pain.

Lead author Dr Giovanni Ferreira from The Institute for Musculoskeletal Health and Sydney Musculoskeletal Health at the University of Sydney said a more nuanced approach to prescribing antidepressants for pain is needed.

“Recommending a list of antidepressants without careful consideration of the evidence for each of those antidepressants for different pain conditions may mislead clinicians and patients into thinking that all antidepressants have the same effectiveness for pain conditions. We showed that is not the case.”

Co-author Dr Christina Abdel Shaheed from The School of Public Health and Sydney Musculoskeletal Health at the University of Sydney said: “The findings from this review will support both clinicians and patients to weigh up the benefits and harms of antidepressants for various pain conditions so that they can make informed decisions about whether and when to use them.”

Dr Ferreira said that there are multiple treatment options for pain, and people should not rely solely on pain medicines for pain relief. “Some pain medicines may have a role in pain management, but they need to be considered as only part of the solution. For some pain conditions, exercise, physiotherapy, and lifestyle changes may also help. Speak to your health professional to learn more about what alternatives might be appropriate for you.”


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