Summary: Antidepressants rarely help chronic pain. A new study looked at eight common antidepressants and how well they treat chronic pain. Researchers found that antidepressants helped only a moderate amount in four of the 41 painful conditions. Chronic pain is common these days, and it is still hard to treat. So doctors often prescribe antidepressants for it, even though there is little proof they help.
Chronic pain has become a big concern in recent years. Some people live with low back pain. Others have osteoarthritis. Others are now diagnosed with fibromyalgia. Sadly, in many people, no one fully understands what causes the pain. Often, the pain lasts long after the problem that started it is gone.
Researchers still wonder why some people get chronic pain and others do not. In recent years, they have learned a lot about understanding and treating it. They know chronic pain is very different from acute (short-term) pain. Acute pain usually comes from a local infection or from wear and tear. Chronic pain has many causes, including changes in the brain, spinal cord and even the nerves out in the body.
So doctors more and more use drugs that act on the brain to treat chronic pain. They also often prescribe antidepressants for it. But studies now show that doctors may be prescribing too many antidepressants for chronic pain.
In some people, chronic pain comes with other symptoms and mood disorders. These people are quite likely to benefit from antidepressants. But most people given antidepressants do not report much benefit. Instead, they are more likely to get side effects.
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.
The researchers looked at eight common antidepressants for chronic pain. They covered 22 pain conditions and 42 separate tests. In 11 of the 42, the drugs seemed to help some. And of those 11, clear, statistically significant gains showed up in only four. One group, SNRIs (serotonin-norepinephrine reuptake inhibitors), seemed to help a bit with back pain, nerve pain, pain after surgery and fibromyalgia. But the drugs did not seem to help much in 36 other kinds of pain. That is not good news.
Researchers noticed something else. Many studies cast doubt on antidepressants for chronic pain. Yet doctors keep prescribing them for it.
Here is what is worrying. Many pain guidelines say to use these drugs. For example, the latest UK guidelines from the National Institute for Health and Care Excellence (NICE) say to use them 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.
This study gives strong proof against the wide use of antidepressants. Clearly, they help only in some cases. So doctors should carefully pick out those patients. Antidepressants may help people with fibromyalgia, osteoarthritis, low back pain and some other conditions. But they do little for most chronic pain patients. Other patients may do better with treatments that are not drugs.
Frequently asked questions
Do antidepressants help chronic pain?
Rarely. A study in The BMJ pooled 26 reviews. Those covered 156 clinical trials and more than 25,000 people. It looked at eight common antidepressants across 42 tests. The drugs helped some in only 11. The gain was statistically significant in just four. For most kinds of chronic pain, they did not help much.
Which antidepressant is best for chronic pain?
In the BMJ study, the group with some benefit was SNRIs (serotonin-norepinephrine reuptake inhibitors). They helped a bit with back pain, nerve pain, pain after surgery and fibromyalgia. For other kinds of pain, the drugs did not seem to help much. So the choice depends on your kind of pain, not on a general rule.
Why do doctors prescribe antidepressants for chronic pain?
Chronic pain often comes from changes in the brain, spinal cord and nerves. So doctors more and more reach for drugs that act on the brain. Treatment guidelines also recommend them. The UK’s NICE guidelines advise antidepressants for chronic pain in adults even when they are not depressed. Doctors keep prescribing them, despite studies that cast doubt on how well they work.
Who is most likely to benefit from an antidepressant for pain?
People whose chronic pain comes with mood disorders or other symptoms are the most likely to benefit. Most people given antidepressants for pain do not report much benefit. They are more likely to get side effects. That is why doctors should carefully pick out the patients who will truly be helped before prescribing.
What are the alternatives if antidepressants do not help my pain?
Antidepressants do little for most chronic pain patients. Many may do better with treatments that are not drugs. The study shows that chronic pain is still poorly understood. It also shows that guidelines lean on drugs that are not proven to help much. Ask for a treatment plan built around the cause of your pain, not a default prescription.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
