Do antidepressants prescribed for chronic pain work?

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About one-third of the world’s people Living with chronic pain (pain that lasts longer than three months), millions of people are prescribed antidepressants to alleviate the condition.

But a new review of previous research published Tuesday found that most antidepressants used to relieve chronic pain are prescribed without sufficient credible evidence of their effectiveness. Furthermore, the potential harm has not been well studied.

2 years of study by non-profit organizations Cochrane found that only the antidepressant duloxetine was effective for short-term pain relief, based on the available evidence. Cochrane is an international collaboration of researchers creating the Cochrane Library, containing a database of systematic summaries addressing major issues in health care.

Marketed under the brand names Irenka and Cymbalta, duloxetine is Serotonin and noradrenaline reuptake inhibitoror SNRI, also increases levels of the feel-good neurochemical dopamine.

“This is a global public health concern,” said lead author Tamar Pincus, a professor and chronic pain researcher at the University of Southampton, UK.

“Chronic pain is a problem for millions of people who are prescribed antidepressants without sufficient scientific evidence and an understanding of the long-term health effects.”

This review included 176 studies with a total of 28,664 participants, examining 25 antidepressants. The study mainly investigated his three types of chronic pain: fibromyalgia, Neuralgia and musculoskeletal pain.

The studies had an average duration of 10 weeks, were randomized controlled trials, and were considered the gold standard in medical research. Seventy-two of the studies were funded by pharmaceutical companies.

Amitriptyline is the most commonly prescribed antidepressant for chronic pain worldwide, says the study. Marketed in the United States under the brand names Elavil and Vanatrip, this antidepressant was approved in the United States in 1961. U.S. Food and Drug Administration To treat depression in adults. Because this drug has serious side effects, it is not commonly used for depression, but Prescribed to treat migraines and chronic pain such as diabetic neuropathy.

However, the authors found that most of the studies on the efficacy of amitriptyline were small and the evidence was unreliable.

milnacipran, Approved by the FDA for Fibromyalgiawas also found to be effective in relieving pain, but scientists are less confident about the drug compared to duloxetine due to limited studies in a small number of people. bottom.

The authors emphasize that people taking antidepressants for chronic pain relief should consult their physicians before stopping the medication due to concerns about new reports.

Antidepressants are thought to help with pain because the body systems that regulate mood and pain overlap.

He said the key question for researchers to answer is not whether antidepressants work for treating pain, but “who do antidepressants work for?” .

“It is surprising that pain manifests differently in different people and that not everyone responds to the same medications because chronic pain may have the same cause, but the biological changes that occur in the nervous system are so diverse. It shouldn’t be done.” Patel was not involved in the review.

“This comprehensive analysis shows that if clinical trials were poorly designed under the assumption that everyone’s pain experience It appears to have only limited therapeutic uses.

Even the antidepressant duloxetine, no studies have examined long-term use of this drug, the review found.

“While we found that duloxetine provided short-term pain relief in the patients studied, we remain concerned about the potential for duloxetine to cause long-term harm due to gaps in the current evidence.” Mr Pincus said.

Future research needs to address the unwanted effects of antidepressant use on chronic pain, the report said, noting that existing data on this are “poor”.

“Duloxetine appears to be very good for short-term pain relief at the moment, but instead of prescribing duloxetine or antidepressants for 3, 4 or 6 weeks, we are prescribing them for 6 weeks. I want to stress that the moon.So it’s really shocking that there’s no evidence of long-term use even for duloxetine,” Pincus said.

Dr Cathy Stannard, Clinical Director of Chronic Pain Guidelines at the National Institutes of Health (NICE) and Pain Specialist at the Integrated Care Board, NHS Gloucestershire, UK, emphasizes the importance of social and social issues said it is. Psychological impact on how people experience pain and the importance of the patient-physician relationship.

“There is good evidence that a caring and consistent relationship with a clinician remains the cornerstone of successful treatment for people in pain,” Stannard, who was not involved in the study, said in a statement. rice field.

“Research shows that what people want most is a strong and empathetic relationship with their caregiver. They want time to discuss what is important to them, have easy access to support and We want to be your partner in care.”

Non-pharmaceutical interventions such as mobility support, debt management, trauma and social isolation are also likely to help people living with pain, she added.