A common treatment for chronic back pain may not be very soothing after all. A new review released on Wednesday suggests that antidepressants provide little or no relief for back pain, although it could have a modest benefit for osteoarthritis and sciatica.
Chronic pain can be an emotional experience, so antidepressants are sometimes prescribed by doctors to help sufferers with their mental suffering. But beyond their typical use, research has also suggested that antidepressants, such as serotonin-norepinephrine reuptake inhibitors (SNRIs), may have a added pain relief effect. Exactly how 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 nerve pain. damaged or by a dysfunctional nervous system.
At least one antidepressant – the drug duloxetine, also known as Cymbalta – was approved in the US to treat chronic nerve pain and back pain. And organizations like the American College of Physicians now recommend duloxetine and for back pain. But, according to the authors of this new paper, published In the BMJ on Wednesday, the overall effectiveness of antidepressants for treating pain is still uncertain.
Their analysis looked at data from 33 randomized, controlled clinical trials examining the use of antidepressants for chronic back pain, as well as hip and knee osteoarthritis, including studies that had not been included in previous evidence reviews, they wrote. These attempts involved over 5,300 participants in total. The main result they analyzed was a reduction in the score reported by people on a pain scale from 1 to 100, any reduction of 10 points or more after three months of treatment being considered a clinical improvement that patients would observe it in their lives.
Overall, the review found that the average reduction in pain for SNRI in the treatment of back pain three months after treatment was only about five points. For osteoarthritis, the average reduction in SNRI 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 a reduced effect on back pain, but that both tricyclic antidepressants and SNRIs could have an effect on the treatment of back pain. sciatica, a certain type of nerve pain that can affect the legs and back. However, the researchers were much less sure about the last two findings, due to the limited data available.
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“Our findings show that antidepressants are largely ineffective for back pain, but may be beneficial for osteoarthritis and sciatica,” wrote lead author Giovanni Ferreira, a researcher studying musculoskeletal health at the University of Sydney in Australia. an email.
The findings do not necessarily mean that no one should use these medications for back pain. Chronic back pain is notoriously difficult to treat and, for some patients, even the hope of a small benefit would be worth trying. But antidepressants have side effects, and both doctors and patients should know in advance that the chances of significant improvement from their use are slim, Ferreira and his team said. There are also other medication-free options that patients can try, such as physical therapy programs and exercise.
“If people are currently taking antidepressants for back pain or osteoarthritis and feel it helps them, we recommend that they continue treatment,” he said. Those who do not benefit from them should consult their doctor before making any changes, although abrupt discontinuation of their use may cause withdrawal symptoms such as anxiety and insomnia.
Another important consideration of the authors is that much of the data they studied came from studies funded by the manufacturers of the antidepressants tested. Industry-funded studies are well known for giving a clearer picture of the evidence, so it’s still possible that the benefits they’ve found here may not be as great as they look.
This should be taken into account when interpreting the results of our analysis, especially for osteoarthritis, in which six out of eight studies were sponsored by pharmaceutical companies, Ferreira said. “Therefore, we need more studies, and these should ideally be conducted by independent investigators with no industrial connections.”