Summary: Chronic pain is a common complaint these days, and it remains challenging to manage. Hence, doctors commonly prescribe antidepressants to manage such pain despite the limited evidence in favor of their use. The new study looked into the use of eight commonly prescribed antidepressants and their role in managing chronic pain. In the study, researchers found that antidepressants were only moderately helpful in four of the 41 painful conditions.
Chronic pain has emerged as a significant cause of concern in recent years. Some are living with low back pain, others with osteoarthritis, and others are now diagnosed with fibromyalgia. Unfortunately, in many individuals, the cause of chronic pain remains poorly understood. Quite often, pain outlives the initial condition that caused the pain in people.
Researchers are still wondering why some develop chronic pain while others do not. In recent years, much progress has been made in understanding and managing chronic pain. Researchers know that chronic pain is quite different from acute pain, which is generally caused by local infection of certain degenerative processes. However, chronic pain occurs due to many reasons, including certain changes in the central and even peripheral nervous systems.
All this means that doctors are increasingly using centrally-acting drugs for managing chronic pain. They are also frequently prescribing antidepressants to manage chronic pain. However, now the studies show that doctors are perhaps over-prescribing antidepressants for chronic pain.
It is true that in some individuals, chronic pain coincides with other symptoms and mood disorders. Such individuals are quite likely to benefit from antidepressants. Nonetheless, the majority of those prescribed antidepressants do not report many benefits. Instead, antidepressants are more likely to cause various side effects in these individuals.
The new study was published in the journal The BMJ. In the study, researchers analyzed the data from 26 reviews that included 156 clinical trials and more than 25,000 participants. Thus, the study was massive.
In the study, they analyzed the efficacy of eight commonly used antidepressants for chronic pain management, covering 22 pain conditions that included 42 distinct comparisons. Out of 42, antidepressants seem to help moderately in just 11 comparisons. And even out of these 11, statistically significant benefits were seen just in four studies. Serotonin-norepinephrine reuptake inhibitors (SNRIs) seem to have some benefits for back pain, neuropathic pain, post-operative pain, and fibromyalgia. However, antidepressants did not appear to help much in 36 other painful conditions. Undoubtedly these are not very encouraging findings.
However, researchers have noticed that despite multiple studies casting doubt on the efficacy of antidepressants for chronic pain, doctors still continue to prescribe these medications for the condition.
What is worrisome is the fact that many treatment guidelines for chronic pain recommend using antidepressants. Thus, the latest National Institute for Health and Care Excellence (NICE) UK guidelines recommend using antidepressants for chronic pain in adults even if they are not depressed.
There are many implications for this study. First, it shows that chronic pain treatment guidelines are still far from perfect. It also shows that chronic pain is still not understood well, and thus healthcare providers continue to depend on therapies that are not proven to help much.
The above study has undoubtedly provided high-quality evidence against the widespread use of antidepressants. It is evident that antidepressants only help in some cases. Hence, doctors should carefully identify such patients. Antidepressants may help those with fibromyalgia, osteoarthritis, low back pain, and other conditions. However, they are of little value for the majority of chronic pain patients. Other patients may even benefit more from other non-pharmacological therapies.