A common treatment for chronic back pain may not be very calming. A new review released on Wednesday suggests that antidepressants, on average, provide little or no relief from back pain, although they may have a modest benefit for osteoarthritis and sciatica.
Chronic pain can be an emotionally draining experience, which is why antidepressants are sometimes prescribed by doctors to help sufferers with their mental suffering. But in addition to its typical use, research has also suggested that antidepressants such as serotonin-norepinephrine reuptake inhibitors (SNRIs) may have a added pain relief It is made. How exactly this happens is still being studied, but it is believed that the same neurotransmitters that regulate mood (and that antidepressants help balance) also play a role in regulating our pain sensations, especially pain caused by damaged or damaged nerves. a dysfunctional nervous system.
At least one antidepressant – the drug duloxetine, also known as Cymbalta – has been approved in the USA to treat chronic nerve and back pain. And organizations like the American College of Physicians now to recommend duloxetine for low back pain as well. But according to the authors of this new article, Published at BMJ on Wednesday, the overall effectiveness of antidepressants in treating pain is still uncertain.
The review looked at data from 33 randomized, controlled clinical trials examining the use of antidepressants for chronic back pain, as well as osteoarthritis of the hip and knees, including trials that were not included in previous reviews of the evidence, they wrote. These tests involved more than 5,300 participants in total. The main result they observed was the reduction in the score reported by people on a pain scale from 1 to 100, with any reduction of 10 points or more after three months of treatment being considered a clinical improvement that patients would notice in their lives.
In all, the review found that the average pain reduction for SNRIs in the treatment of low back pain three months after starting treatment was only about five points. For osteoarthritis, the mean reduction in SNRIs was just under 10 points, so it is more likely to be a significant improvement. Other evidence also suggested that tricyclic antidepressants, an older class of drugs, had little effect on back pain, but that both tricyclic antidepressants and IRSNs may have an effect on the treatment of sciatica, a specific type of nerve pain. that can affect the legs and back. However, the researchers were much less certain about the last two findings, due to the limited data available.
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“Our results show that antidepressants are largely ineffective for back pain, but they can be beneficial for osteoarthritis and sciatica,” wrote lead author Giovanni Ferreira, a researcher who studies musculoskeletal health at the University of Sydney, in Australia.
The findings do not necessarily mean that no one should use these drugs for back pain. Chronic back pain is notoriously difficult to treat and, for some patients, even the hope of a small benefit is worth trying. But antidepressants have side effects, and doctors and patients should know from the beginning that the chances of significant improvement with use are likely to be small, Ferreira and his team noted. There are also other non-drug options that patients can still try, such as physical therapy and exercise programs.
“If people are taking antidepressants for back pain or osteoarthritis and feel it is helping them, we recommend that they continue treatment,” he said. Those who are not benefiting from them should consult their doctor before making any changes, as abrupt discontinuation of use can cause withdrawal symptoms like anxiety and insomnia.
Another important consideration raised by the authors is that much of the data they studied came from trials funded by the manufacturers of the tested antidepressants. Industry-funded tests are well known for painting a more optimistic picture of the evidence, so it’s still possible that even the benefits they found here may not be as big as they seem.
“This must be taken into account when interpreting the results of our review, especially for osteoarthritis, where six of the eight trials were sponsored by pharmaceutical companies,” said Ferreira. “That’s why we still need more tests, and they should be conducted by independent researchers, with no ties to the industry.”