About one in five people globally live with chronic pain, and it is a common reason for seeing a doctor, accounting for one in five GP appointments in the UK.

There is  growing caution around prescribing opioids – given their potential for addiction – many doctors are looking to prescribe other drugs  to treat long-term pain. A popular option is antidepressants.

In the UK, doctors can prescribe the following antidepressants for “chronic primary pain” (pain without a known underlying cause): amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine and sertraline. Amitriptyline and duloxetine are also recommended for nerve pain, such as sciatica.

A recent review of studies investigating the effectiveness of antidepressants at treating chronic pain found that there is only evidence for one of these drugs: duloxetine.

The review found 178 relevant studies with a total of 28,664 participants. It is the largest-ever review of antidepressants for chronic pain and the first to include all antidepressants for all types of chronic pain.

Forty-three of the studies (11,608 people) investigated duloxetine. The review found that it moderately reduces pain and improves mobility. It is the only antidepressant that was found to be reliably beneficial. Further, the review found that a 60mg dose of duloxetine was equally effective in providing pain relief as a 120mg dose.

The review also looked at studies involving amitriptyline, citalopram, fluoxetine, paroxetine and sertraline and found that that the evidence for benefit was very poor, and no conclusions could be drawn about their ability to relieve pain.

This suggests that millions of people may be taking an antidepressant to treat pain even though there is no evidence for its usefulness.

In light of these findings, which were published in May 2023, the UK’s National Institute for Health and Care Excellence (Nice) recently updated its advice to doctors on how to treat chronic pain.

The updated Nice guidance now suggests 60mg of duloxetine to treat [chronic primary pain] and the same drug and dose to treat nerve pain.

 

Comment – we are increasingly seeing the limited benefit of medicines in the management of chronic pain and that is why we believe it is so important for sufferers to learn to live better with their pain condition.