Some doctors prescribe antidepressants because persistent pain, such as chronic back and neck pain, is difficult to treat.Currently, a review of the evidence shows that these drugs rarely work as treatments.
health
February 1, 2023
Chronic pain can be difficult to treat Dragos Chondrea/Alamy
People with long-term pain are often prescribed antidepressants when other treatments have failed, but reviews of clinical trials show that most such drugs are not used in this manner. Little evidence was found to support it.
It is estimated that about 1 in 5 people have ongoing pain from a variety of causes, including arthritis, nerve damage, and locations such as the back and neck.
However, treatment options are limited. Opioid-based medications are effective for new-onset pain, but can become addicting if used long-term. However, prolonged use can damage the stomach, kidneys, and heart.
This may be why some doctors offer antidepressants as a treatment for long-term pain.
Some people with chronic pain have depression and anxiety. So while doctors can see the drug primarily as helping these conditions, antidepressants are thought to have other pain-relieving effects as well. The mechanism is unknown, but at least in animal studies, it is believed that antidepressants reduce inflammation.
The use of antidepressants for pain is difficult to quantify. This is because official figures for drugs generally do not record the medical conditions for which they were prescribed.
However, various studies give suggestions. For example, one study suggests that one in ten antidepressant prescriptions in Canada is for pain, while recent statistics in the UK and US show that among people over the age of 65, , suggest that chronic pain was the most common reason for taking antidepressants. “They’ve been used for pain for quite some time,” says Giovanni Ferreira of the University of Sydney.
Ferreira and his colleagues are currently analyzing the results of 156 randomized trials involving more than 25,000 participants for a detailed analysis of the supporting evidence. They examined the effectiveness of eight different antidepressants in treating 22 pain conditions with widespread muscle pain, including back pain, postoperative pain, and fibromyalgia.
The team studied a class of drugs called tricyclic antidepressants, the most common type used to treat pain in the UK, and the most common type used in the US.
One class that had evidence of efficacy was a class called serotonin and norepinephrine reuptake inhibitors (SNRIs). However, these methods also reduced the pain slightly. Less than 10 points on a scale of 0 to 100. Subjective evaluation of one’s pain in numerical terms is the only way to measure the severity of pain, further complicating the diagnosis and treatment of pain.
This analysis reaches different conclusions than a 2021 review by the National Institute for Health and Medical Research (NICE), the medical guidelines body for England and Wales. This should only be done after discussing the potential benefits and harms. The difference in conclusions may be because the latest analysis included more trials and considered each pain condition separately, says Ferreira.
Cathy Stannard of the NHS Gloucestershire Integrated Care Board, Gloucester, UK, who advised on the NICE guidelines, said the new review does not mean that physicians should rule out antidepressants. Some will benefit, but there’s no way to predict who it will be,” she says.
But it’s unlikely there’s a pharmacological “magic bullet” for chronic pain, Stannard says. Consider trying to cope with other life challenges such as stress and social isolation.
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