Stimulant medications for back pain and osteoarthritis are usually not enough, despite being widely used for these conditions, suggests a study published by the British Medical Journal (BMJ).
The findings, based on moderately conclusive evidence, show that the effects were too small to be valuable for people with back pain, but for osteoarthritis, a small beneficial effect cannot be ruled out.
Most clinical practice guidelines recommend antidepressants for chronic (chronic) back pain and hip and knee osteoarthritis, but evidence supports the use inconclusive. To address this knowledge gap, researchers led by Giovanni Ferreira at the University of Sydney commissioned a study of the efficacy and safety of antidepressants for back pain and osteoarthritis compared to placebo.
Their findings are based on an analysis of published data from 33 randomized controlled trials involving more than 5,000 adults with low back or neck pain, sciatica, or hip or knee osteoarthritis.
The experiments were designed differently and were of different quality, but the researchers were able to allow for this in their analysis. Most of the data came from industry-backed experiments.
The researchers set a difference of 10 points on a scale of 0 to 100 points for pain or disability as the most worthwhile difference between groups – a threshold commonly used in other studies of chronic pain.
Results showed that serotonin-norepinephrine reuptake inhibitors (SNRIs) reduced back pain after three months. But the effect was small – an average difference of 5.3 points on the pain scale compared with placebo – and unlikely to be considered clinically significant by the majority of patients.
For osteoarthritis, they found a slightly stronger effect of SNRIs on pain after three months – an average difference of 9.7 points on the pain scale compared with placebo – meaning that a valuable effect could not be ruled out.
Evidence with low certainty showed that tricyclic antidepressants (TCAs) were ineffective for back pain and associated disability.
Tricyclic antidepressants and SNRIs may reduce pain in people with sciatica, but the evidence was not conclusive enough to reach strong conclusions.
The researchers acknowledge a number of limitations, including the inability to miss tests and the inability to study dose-response relationships for most antidepressants due to the low number of studies released. across six different classes of antidepressants.
Nonetheless, the review was based on a complete literature review with a designated threshold for clinical significance used in other reviews of treatments for back pain and osteoarthritis.
Therefore, they say their review updates the evidence for back pain, sciatica, and osteoarthritis, and could help clinicians and their patients decide whether to them to take antidepressants for chronic pain.
But they conclude: “Large randomized trials that are free of industry ties are urgently needed to resolve uncertainty about the efficacy of antidepressants for sciatica and osteoarthritis revealed by this review.”
In a linked edition, researchers at the University of Warwick want clearer guidance to inform a consistent approach to the use of antipsychotic medications for people with pain disorders.
They acknowledge that some patients may opt for antidepressants for a small chance of a significant reduction in pain after three months.
Overall, however, they claim that drug treatment is largely ineffective for back pain and osteoarthritis and has the potential to cause serious harm.
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This story was published from a wire group group with no text changes. Only the headline has changed.
