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A Cochrane review of antidepressants used for chronic pain has found that there is insufficient evidence to determine how effective or harmful they may be.
One third of people globally are living with long-term pain with many prescribed antidepressants to relieve symptoms, yet there has never been a comprehensive study examining all medications across all chronic conditions.
The Cochrane review, led by scientists from several UK universities including Southampton and Newcastle, examined 176 trials consisting of nearly 30,000 patients involved in assessments which prescribed antidepressants for chronic pain.
It reviewed commonly prescribed medications including amitriptyline, duloxetine, fluoxetine, citalopram, paroxetine, and sertraline. Only duloxetine showed reliable evidence for pain relief.
Antidepressants and chronic pain
Lead author Professor Tamar Pincus from the University of Southampton said: “This is a global public health concern. Chronic pain is a problem for millions who are prescribed antidepressants without sufficient scientific proof they help, nor an understanding of the long-term impact on health.
“Our review found no reliable evidence for the long-term efficacy of any antidepressant, and no reliable evidence for their safety for chronic pain at any point. Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence.”
The two-year Cochrane study was the largest ever assessment of antidepressants recommended by leading bodies including NICE and the US Food and Drug Administration (FDA).
Statistician Gavin Stewart, review co-author from Newcastle University, said: “We are calling on governing health bodies NICE and the FDA to update their guidelines to reflect the new scientific evidence, and on funders to stop supporting small and flawed trials. Evidence synthesis is often complex and nuanced but the evidence underpinning the use of these treatments is not equivalent, so current treatment modalities are hard to justify.”
The review revealed that duloxetine was consistently the highest-rated medication and was equally as effective for fibromyalgia, musculoskeletal, and neuropathic pain conditions. Standard doses were also successful for reducing pain as higher quantities.
Milnacipran was also effective at reducing pain, but scientists are not as confident as duloxetine due to fewer studies with fewer people.
Prof Tamar Pincus added: “We simply cannot tell about other antidepressants because sufficiently good studies are not available – but it does not mean that people should stop taking prescribed medication without consulting their GP.”