Do antidepressants help with chronic low back pain and osteoarthritis?

Antidepressants are commonly used to treat pain around the world, but a new study from the University of Sydney shows that they can be of little or no use and harm to people suffering from chronic low back pain or osteoarthritis. There is even sex.

back pain And knees Osteoarthritis It affects millions of people around the world and is a major cause of disability.Many people are prescribed if primary analgesics such as paracetamol or ibuprofen cannot improve their symptoms Antidepressant Because of their pain.most Medical practice guidelines Antidepressants are recommended for long-term (chronic) low back pain and osteoarthritis of the hip and knee, but evidence to support their use is unknown.

Released today BMJ This study investigated the efficacy and safety of antidepressants in the treatment of low back pain and osteoarthritis compared to placebo. The authors hope that this study will help clinicians and patients make more informed decisions about whether to treat chronic low back pain and osteoarthritis pain with antidepressants. ..

“Treat people with antidepressants Chronic low back pain Osteoarthritis is on the rise worldwide, but prior to our study it was not clear whether antidepressants were pain-relieving or safe, “said the University of Sydney and Sydney Local. Dr. Giovanni Ferreira, a postdoctoral fellow at the Institute of Musculoskeletal Health and the lead author, said. Health District and University School of Medicine and Health.

“We have conducted a review of all randomized clinical trials evaluating the effectiveness of antidepressants in people with low back pain or knee osteoarthritis, and antidepressants are ineffective or have very little effect on low back pain. Found not to provide. This is unlikely to be perceived as valuable by. Most patients. For people with knee osteoarthritis, the effect is still small, but for some patients May be perceived as worthwhile, “he said.

“Some antidepressants are of concern because they significantly increase the risk of a person experiencing an adverse event. Many people are treated with these drugs that do not relieve pain and can be harmful. It has been.”

About research:

This study was a systematic review and meta-analysis involving 33 randomized controlled trials of more than 5,000 participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.

The study tested six classes of antidepressants, including serotonin-noradrenaline reuptake inhibitors (SNRIs) and tricyclic antidepressants.

In this study, we set a 10-point difference on the 0-100 scale of pain as the least valuable difference between groups, which is a common threshold in chronic pain studies.

most Clinical trial The review did not include patients with pain and depression. The results apply to patients treated with these drugs for their painful condition, not for depression in painful people.

Main findings:

• SNRI had only a slight effect on low back pain and reduced pain by 5.3 out of 100 on a pain scale compared to placebo after 3 months. This amount is unlikely to be considered clinically significant by most patients.
• SNRI had a slightly stronger effect on osteoarthritis pain after 3 months, with an average difference of 9.7 points on the pain scale compared to placebo. This amount is still small, but it is close to the 10-point difference that some patients need to consider antidepressants worthwhile.
• Tricyclic antidepressants were ineffective for low back pain and related disorders — tricyclic antidepressants and SNRIs can reduce pain in people with sciatica (back pain-related leg pain) There is sex, but there was not enough evidence to draw a firm conclusion.
• SNRI antidepressants have significantly increased the risk of patients experiencing adverse events. About two-thirds of patients taking this class of antidepressants had at least one adverse event, such as nausea.

Professor Andrew McCraclan, director of the University of Sydney and pharmacy and co-author of the study, said antidepressants for those who are currently taking antidepressants to treat back pain and osteoarthritis. We strongly advise you to consult your doctor rather than suddenly discontinue your medication. ..

“This can lead to withdrawal symptoms that can be painful and sometimes manifest as serious health problems. These withdrawal symptoms include dizziness, nausea, anxiety, agitation, tremors, and sweating. Includes confusion and sleep disorders. “

“Further research is needed to resolve the uncertainty about the effectiveness of antidepressants for sciatica and osteoarthritis highlighted in this review,” Dr. Ferreira added.