| back pain

“Uncertain Evidence” of Antidepressant Treatment for Pain

Investigating Efficacy/Safety of Antidepressants

Do antidepressants offer pain relief for osteoarthritis and back pain? Researchers published findings in the British Medical Journal, describing their systematic review and meta-analysis of 33 trials with 5318 participants, given either serotonin-noradrenaline reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs) vs placebo. Both of these conditions—OA and back pain—are leading causes of pain and disability throughout the world, and the article states that “antidepressants are the fourth most prescribed medicine for low back pain in the US. More than one quarter of Americans with chronic low back pain are prescribed an antidepressant within three months of a first diagnosis.” But what is their level of efficacy?

The study concluded, “Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low.” Dr Giovanni Ferreira, lead author of the study, commented, “The use of antidepressants to treat people with chronic back pain and osteoarthritis is increasing worldwide… It is concerning as some antidepressants significantly increase the risk of a person to experience adverse events. Many people are being treated with these medications that may not be helping their pain and may be doing them harm.”

 

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