Summary: Chronic pain has a bidirectional relationship to mood disorders like depression. Thus, doctors frequently use antidepressants to manage chronic pain. However, the most extensive study to date shows that there is little evidence that antidepressants help. There is only some evidence in favor of one of these drugs.
Antidepressants are widely prescribed to manage chronic pain. However, a new study, one of the most extensive to date, analyzing data from hundreds of other studies published by one of the most reputable journals, Cochrane Review, shows little evidence that antidepressants help.
Chronic pain is one of the most common causes of disability globally, affecting one-third of the population, which means that billions are affected by chronic pain globally.
However, chronic pain is very different from acute pain. Acute pain is a survival mechanism; such pain lasts only as long as the underlying cause, like unhealed physical trauma or a wound.
In contrast, chronic pain is a very different and often poorly understood phenomenon. Such pain may start for no apparent reason or outlast the event that initiated the pain. It occurs for many reasons, such as psychological, tissue, nerve damage, and even hypersensitivity of the nervous system.
Non-steroidal anti-inflammatory drugs (NSAIDs) are the treatment of choice for most pains. However, they fail to help adequately in chronic pain. Thus, doctors often prescribe other drugs, like opioids, anti-anxiety drugs, sedatives, anti-seizure, and antidepressants. However, the prescription of these second-line drugs does not essentially help. Moreover, in many cases, doctors prescribe them off-label, believing that they might help.
Of course, doctors have a reason to prescribe these drugs. They want to help patients. Some treatment guidelines might even recommend them. However, these second-line drugs are highly toxic and rarely help. They might cause more side effects than good.
Since chronic pain has a bidirectional relationship with mood disorders like depression, the use of antidepressants as a part of chronic pain treatment is very common. Many doctors would opt for these drugs if NSAIDs fail to help. However, new studies have questioned this approach. Such an approach might be causing more harm than good.
Little Evidence that Antidepressants Help with Chronic Pain
This new study is the largest investigation to date. The purpose of the study was to understand if antidepressants help or not. There are some studies claiming that they might be of some help, while others ruling out any benefit. So, what is the truth?
This study looked into the most commonly prescribed antidepressants for chronic pain in the UK. These antidepressants are also commonly used in the US, too. They explored the role of amitriptyline, duloxetine, fluoxetine, citalopram, paroxetine, and sertraline in managing chronic pain.
This was a systemic review – a kind of study that pools data from other studies. So, this study published in the Cochrane Review included 176 clinical studies with a total of 30,000 patients. This study continued for two years as it analyzed massive amounts of data regarding the use of antidepressants for chronic pain management.
Researchers say that they found little evidence that antidepressants are of any use. They do not appear to help with chronic pain, except for one of the drugs, duloxetine. It seems that only this specific drug has some role in managing chronic pain.
This means that some of the most popular antidepressants, like amitriptyline or sertraline, have almost no role in managing chronic pain.
Further, researchers noticed that when these antidepressants do not help, doctors tend to increase their dose, sometimes to the maximum. However, this strategy does not help. It is only likely to increase the risk of side effects.
Even in the case of duloxetine, the only antidepressant that appears to be of some help, increasing its dosage does not result in greater pain relief. Thus, if this specific drug is prescribed, it should be prescribed in its regular strength.
Hence, researchers said that this study puts an end to all the controversies around the widespread use of antidepressants for chronic pain. They say that all small clinical studies showing their effectiveness are flawed. Hence, it is time that doctors stop using these drugs for managing chronic pain.
Source:
Most antidepressants prescribed for chronic pain lack reliable evidence of efficacy or safety, scientists warn. (n.d.). Retrieved May 27, 2024, from https://www.cochrane.org/news/most-antidepressants-prescribed-chronic-pain-lack-reliable-evidence-efficacy-or-safety
