Antidepressants seem to be largely ineffective for common pain conditions
Some antidepressant drugs do help in some pain conditions, but most are either ineffective or the evidence is inconclusive, despite being used for a range of pain conditions. The evidence, published by The British Medical Journal adds to mounting research that challenges the role of medicines for pain.
The use of antidepressant has doubled in many countries in recent years and their off-label (unapproved) treatment of common pain conditions such as osteoarthritis, fibromyalgia and persistent headaches, is thought to have contributed to this rise. So a team from Australia has looked in depth at the research using data from over 25,000 people. They found that:
- No review provided high certainty evidence on the effectiveness of antidepressants for pain for any condition;
- Moderate evidence suggested that serotonin-norepinephrine reuptake inhibitors (SNRIs) were effective for back pain, postoperative pain, fibromyalgia and neuropathic pain;
- Low certainty evidence suggested that SNRIs were effective for pain linked to knee osteoarthritis, breast cancer treatment and pain related to other underlying conditions;
- For the other 31 comparisons between health conditions and antidepressants, the drugs were either not effective or the evidence was inconclusive;
- Around 45% of the trials were supported by industry (ie the companies that make the drugs).
Most safety and tolerability data were imprecise, suggesting that the safety of antidepressants for several conditions is still uncertain.
These findings suggest that antidepressant treatment will be disappointing for most adults living in chronic pain. Doctors continue to prescribe medicines for which the evidence is poor because they see that some people do respond to them, albeit modestly. But less potentially harmful options, such as exercise and support with mobility and social isolation, can help people to live well with pain.
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