Antidepressants for Chronic Pain: The Evidence Gap Revealed

11 May 2023 • A recent comprehensive Cochrane review has revealed that most commonly prescribed antidepressants for chronic pain lack sufficient evidence to support their effectiveness. The study examined 176 randomized controlled trials involving 28,664 participants and investigated antidepressants such as amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine.

The researchers found that only duloxetine showed some evidence of short-term pain relief, particularly for fibromyalgia, musculoskeletal, and neuropathic pain conditions. However, the long-term efficacy and safety of these medications remained uncertain due to limited evidence, as most studies had an average duration of only 10 weeks.

Lead author Tamar Pincus, from the University of Southampton, emphasized the need for caution due to potential long-term harm associated with antidepressant use for chronic pain. The researchers highlighted the lack of robust studies for other commonly prescribed antidepressants like amitriptyline, further underscoring the need for more conclusive evidence.

The study suggests adopting a person-centered approach to treatment decisions, with a preference for starting with duloxetine, the antidepressant with the most reliable evidence for pain relief. It also emphasized the importance of considering social and psychological factors in managing chronic pain and recommended exploring additional support services tailored to individual needs.

These findings shed light on the limited evidence supporting the use of antidepressants for chronic pain and call for further research to establish their long-term efficacy and safety.

Source: BMJ | Read full story

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