Antidepressants are commonly used around the world to treat pain, but new research from the University of Sydney shows that they offer little help to people suffering from chronic back pain and osteoarthritis and may even cause damage.
Back pain and knee osteoarthritis affect millions of people worldwide and are major causes of disability. When first-line pain medications such as paracetamol and ibuprofen fail to improve symptoms, many people are taking antipsychotic medications for their pain. Most clinical practice guidelines recommend antidepressants for chronic (chronic) back pain and hip and knee osteoarthritis, but evidence supports the use inconclusive.
Published today in the BMJ the study examined the efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis compared with placebo. The authors hope that this study could help clinicians and patients make more informed decisions about treating chronic back pain and osteoarthritis pain with antidepressant medications.
“The use of antidepressants to treat people with chronic back pain and osteoarthritis is growing worldwide, but prior to our work, it was unclear whether antidepressants relieved pain or were safe,” he said. lead author Dr Giovanni Ferreira, a postdoctoral researcher at the Institute for Musculoskeletal Health at the University of Sydney and Sydney Local Health Area and Faculty of Medicine and Health Sciences.
“We reviewed all randomized clinical trials evaluating the effectiveness of antidepressants for people with back pain or knee osteoarthritis and found that the antidepressant medications were either ineffective or did not provide an effect. very few, which was not seen as worthwhile by most patients. For people with osteoarthritis, the effects were still small, but some patients may see them as worthwhile, “he said.
“It’s worrying because some antidepressants significantly increase a person’s risk of having adverse events. Many people are being treated with these medications that may not help their pain and they could be harmed. “
About the study:
The study was a systematic review and meta-analysis that included 33 randomized controlled trials with more than 5,000 participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.
The trials tested six classes of antidepressants including serotonin-noradrenaline reuptake inhibitors (SNRIs) and tricyclic antidepressants.
The study set a 10-point difference on a 0–100 scale for pain as the most worthwhile difference between groups, which is the common threshold in studies of chronic pain.
The majority of clinical trials included in the review did not include patients with pain and depression. The results apply to patients treated with these drugs for their pain condition, not depression in people living with pain.
Key results:
- – SNRIs had a small effect on back pain, reducing pain by just 5.3 points out of 100 on the pain scale compared to placebo after three months. This amount is unlikely to be clinically significant for most patients.
– SNRIs had a stronger effect on osteoarthritis pain after three months, with an average difference of 9.7 points on the pain scale compared with placebo. This amount is still small, but close to the 10-point difference required for some patients to evaluate antidepressants.
– Tricyclic antidepressants were ineffective for back pain and associated disability
– Tricyclic antidepressants and SNRIs may reduce pain in people with sciatica (pain down the leg associated with back pain), but the evidence was not conclusive enough to draw strong conclusions.
– SNRI antidepressants significantly increase the risk of patients experiencing side effects; about two-thirds of patients taking this class of antidepressant had at least one adverse event such as nausea.
Professor Andrew McLachlan, Head of School and Dean of Pharmacy at the University of Sydney and co-author of the study, strongly advises those currently taking antipsychotic medication to be treat back pain and osteoarthritis without abrupt cessation of treatment with antipsychotic medications but in consultation with their doctor.
“This can lead to withdrawal effects that can be distressing and sometimes serious health issues. These withdrawal effects include cooling, discomfort, anxiety, restlessness, trembling, sweating, sleep disturbances and anxiety. “
Dr Ferreira said: “More research is needed to resolve uncertainty about the effectiveness of antidepressants for sciatica and osteoarthritis revealed by this review.”
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