Millions of individuals are given antidepressants to treat their chronic pain, which affects around one third of people worldwide and affects them for more than 3 months.
However, a recent assessment of earlier research indicated that the majority of antidepressants used to treat chronic pain are being administered without enough valid proof of their efficacy.
Additionally, possible risks haven’t been thoroughly researched.
According to the available data, just one antidepressant, namely duloxetine, was beneficial for relieving short-term pain, according to a two-year review by the nonprofit organization Cochrane.
Cochrane is a group of academics from several countries that work together to create the Cochrane Library, which has a library of systematic summaries addressing important issues in healthcare.
Duloxetine is a norepinephrine and serotonin reuptake inhibitor (SNRI) that also increases levels of the feel good neurochemical dopamine.
It’s marketed under the trade names Irenka and Cymbalta.
Lead author Tamar Pincus says that “This is a global health concern. Chronic pain is a huge issue for millions who are prescribed antidepressants without sufficient proof they help, nor an understanding of the long term impact on health.”
The evaluation included 25 different antidepressants and comprised 176 trials with a total of 28,664 participants.
Fibromyalgia, nerve pain, and musculoskeletal pain were the three primary kinds of chronic pain that were the focus of the investigations.
The investigations were randomized controlled trials, which are considered the gold standard in medical research, and had an average duration of ten weeks.
Pharmaceutical firms provided funding for 72 of the investigations.
According to the report, amitriptyline is the antidepressant that is most frequently given for chronic pain worldwide.
The antidepressant, which is available in the US under the trade names Elavil and Vanatrip, was authorized by the FDA in 1961 in order to treat adult depression.
Although the drug has serious adverse effects, it is frequently used to treat headaches and chronic pain, including diabetic neuropathy, rather than depression.
However, the majority of the studies on the efficacy of amitriptyline were tiny, and the data was unreliable, according to the authors.
The FDA approved medication milnacipran for fibromyalgia was similarly successful in reducing pain, according to the analysis, but due to its less extensive research and small sample size compared to duloxetine, experts were less optimistic about it.
The authors emphasized that anybody who is taking antidepressants for the treatment of chronic pain should see their doctor before quitting the drug owing to concerns regarding the current study.
Ryan Patel, a researcher who studies chronic pain, noted that antidepressants are believed to help with pain because the biological systems that govern mood and pain overlap.
According to him, the most important question for academics to address is “for whom are antidepressants useful,” not whether they are successful in treating pain or not.
Patel, who was not directly involved in the research, stated that “Even when the cause of chronic pain is the same, biological changes that occur in the nervous system are still varied and so it’s no surprise pain presents differently from person to person, and not everybody will respond to the same drugs. What this analysis demonstrates is that when clinical trials get designed poorly under an assumption that everybody’s experience of pain is uniform, most antidepressants seem to have limited use for treating chronic pain.”
The analysis discovered that there was no data on long-term usage of any medication, not even the antidepressant duloxetine.
Pincus said that “Though we did find duloxetine provided short term pain relief for patients we studied, we are still concerned about its possible long term harm due to the gaps in evidence.”
The committee stressed that the available data on this was “limited,” and suggested that future research should address the potential negative consequences of using antidepressants for chronic pain.
“Duloxetine does look very good at the moment for short term pain relief, but I just want to emphasize that patients are not prescribed duloxetine or any other antidepressant for 3 weeks, 4 weeks, 6 weeks, they are prescribed it for 6 months. So it is really shocking that we do not have any evidence for long term use of duloxetine,” Pincus went on to state.
Dr. Cathy Stannard, a pain expert, stressed the significance of a patient’s connection with their doctor and the social and psychological factors that affect how people feel pain.
Stannard, who wasn’t involved in the study, pointed out that “There is significant evidence that for those with pain, compassionate and consistent relationships with clinicians remain the foundations of successful care. Research shows that what people want the most is a strong, empathic relationship with their care provider. They want more time to discuss what matters to them and they want easy access to support and be partners in their care.”
She continued, mentioning that non-pharmaceutical therapies, such as assistance with mobility, financial management, social isolation and trauma, were also likely to benefit those who were experiencing pain.