The use of antidepressants to help manage a person’s pain is on the rise, even when they do not have a mood disorder like depression.
In a study from the University of Sydney and elsewhere, scientists found that some classes of antidepressants were effective in treating certain pain conditions in adults, but others were either not effective, or the effectiveness was unknown.
The team reviewed the safety and effectiveness of antidepressants in the treatment of chronic pain.
The researchers say the results show that clinicians need to consider all the evidence before deciding to prescribe antidepressants for chronic pain management.
In the study, the team examined 26 systematic reviews from 2012 to 2022 involving over 25,000 participants.
This included data from 8 antidepressant classes and 22 pain conditions including back pain, fibromyalgia, headaches, postoperative pain, and irritable bowel syndrome.
They found serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants such as duloxetine were effective for the largest number of pain conditions, such as back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and neuropathic pain (nerve pain).
By contrast, tricyclic antidepressants, such as amitriptyline, are the most commonly used antidepressant to treat pain in clinical practice, but the team showed that it is unclear how well they work, or whether they work at all for most pain conditions.
The use of antidepressants as a treatment for pain has recently gained attention globally.
A 2021 guideline for chronic primary pain management published by The National Institute for Health and Care Excellence (NICE) recommends against using pain medicines with the exception of antidepressants.
The guideline recommends different types of antidepressants, such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline for adults living with chronic primary pain.
The team says a more nuanced approach to prescribing antidepressants for pain is needed.
If you care about pain, please read studies about vitamin K deficiency linked to hip fractures in old people, and these vitamins could help reduce bone fracture risk.
For more information about health, please read studies that drinking electrolytes may help reduce muscle pain, and common fever and pain meds may raise your COVID-19 risk.
The study was conducted by Dr. Giovanni Ferreira et al and published in The BMJ.
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