Antidepressants in Chronic Pain – Any good?
Date: 08th February 2023 | By: Dr Lourdes Gaspar
Despite it being a frequent practice, there is limited evidence supporting the prescription of antidepressant drugs to help treat pain conditions.
In new data from an overview of systematic reviews conducted by an international team of investigators, approximately only 1 in every 4 comparison trials showed an efficacy of antidepressants in the treatment of pain conditions including back neuropathic and fibromyalgia pain.
The findings highlight a need to improve guidance and rationale behind the use of drug classes including serotonin-norepinephrine reuptake inhibitors (SNRIs) in matters of pain management.
- Antidepressant drugs are frequently prescribed to treat pain conditions, but limited evidence supports their efficacy.
- The findings showed that only 11 out of 42 trial comparisons had at least moderate evidence of efficacy, including SNRIs for forms of chronic pain.
- The rest of the comparisons (74%) showed either inefficacy or inconclusive evidence on the efficacy of antidepressants for pain.
As antidepressant use has doubled in OECD* countries from 2000 to 2015. Investigators stressed these findings show how little is understood behind the prescription of antidepressants for chronic pain conditions.
( *OECD Organization for Economic Cooperation – currently 36 Member countries in the OECD which spans the globe, from North and South America to Europe and Asia-Pacific including the US)
They said, “We found evidence of efficacy of antidepressants in 11 of the 42 comparisons included in this overview of systematic reviews,” they concluded. “For the other 31 (74%) comparisons, antidepressants were either inefficacious or evidence on their efficacy was inconclusive.”
The investigators went to comment, “This overview adds to mounting evidence challenging the use of medicines for pain,” they wrote. “In consequence, a real opportunity is emerging to focus more on what living with pain means for individuals and to change how we think about pain. Effective care and research can only grow from new, more equal partnerships between clinicians, people living with pain, and researchers.”
The research was commented upon in an editorial in the British Journal of Medicine (BMJ) who stated
“In its most recent guidance on chronic pain, the UK National Institute for Health and Care Excellence (NICE) evaluated the benefits and harms of medicines used for chronic primary pain (pain not adequately explained by any underlying condition). Antidepressants are the only drugs where this balance proved favourable, and NICE recommended clinicians “consider” their use because of the current gaps in evidence.”
They went onto say,
“Clinical guidelines are not rules but valuable aids to decision making. Clinicians continue to prescribe medicines for which the evidence is poor because they observe that some people respond to them, albeit modestly. But all medicines carry risk of harm and there are other, less potentially harmful options more likely to help people to live well with pain.”
There is growing evidence for the use of psychological therapies for the management of Acceptance and Commitment Therapy which also currently features prominently the UK NICE guidance.
We believe that our program ACTforPAIN represents an evidence based, affordable and sustainable alternative to “tablet” based approach to managing chronic pain.
- Ferreira GE, Abdel-Shaheed C, Underwood M, et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. BMJ. 2023;380:e072415. Published 2023 Feb 1. doi:10.1136/bmj-2022-072415
- Stannard C, Wilkinson C. Rethinking use of medicines for chronic pain. BMJ. 2023;380:p170. Published 2023 Feb 1. doi:10.1136/bmj.p170