COVENTRY, United Kingdom — Do antidepressants really help people dealing with chronic pain? A new study says the answer isn’t as clear as many patients would like. However, the results do show that there are many types of these prescription drugs which do almost nothing at all for someone’s pain.

The international team notes that doctors commonly prescribe antidepressants for other ailments besides depression. This includes back pain, fibromyalgia, headaches, postoperative pain, and even irritable bowel syndrome. Although more and more people are taking these drugs, the new study finds that there is little concrete data showing that antidepressants actually relieve pain. Although some antidepressants displayed an ability to treat pain in adults, several others displayed no effectiveness, or their effectiveness was still unclear.

“There is a role for antidepressants in helping people living with chronic pain, however, this is more limited than previously thought,” says study co-author Professor Martin Underwood from the University of Warwick in a media release.

“Antidepressants may have unpleasant side effects that patients may wish to avoid. We need to work harder to help people manage their pain and live better, without relying on the prescription pad.”

Which antidepressants actually treat pain?

Researchers reviewed 26 studies on antidepressant use for chronic pain, conducted between 2012 and 2022, involving over 25,000 people. The studies contained information on eight antidepressant classes and 22 different conditions which cause patients pain. This included 42 distinct antidepressant-versus-placebo comparisons.

Study authors note that none of the reports delivered high-quality evidence that antidepressants treat chronic pain resulting from any condition.

Among the studies which found some evidence, serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants were the most effective at treating pain from certain conditions, including back pain, postoperative pain, fibromyalgia, and nerve pain. These drugs include prescription medications like duloxetine — which is available under the brand name Cymbalta.

There was some low-quality evidence that duloxetine may also treat pain from breast cancer treatment, depression, knee osteoarthritis, and pain related to other underlying health conditions.

A common antidepressant does little to nothing for pain

On the other hand, researchers could not find evidence that tricyclic antidepressants help treat chronic pain — despite these drugs being one of the most common antidepressants prescribed for the treatment of pain. Tricyclic antidepressants include amitriptyline, which are available under the brand name Elavil.

For 31 of the pain comparisons, the study reveals that antidepressants are either not effective (five comparisons) or the evidence is inconclusive (26 comparisons). Most of the safety and tolerability data is imprecise as well, indicating that the safety of antidepressants for several conditions is still a mystery.

“These findings suggest that for most adults living with chronic pain, antidepressant treatment will be disappointing,” the researchers write in a statement.

“Recommending a list of antidepressants without careful consideration of the evidence for each of those antidepressants for different pain conditions may mislead clinicians and patients into thinking that all antidepressants have the same effectiveness for pain conditions. We showed that is not the case,” adds lead author Dr. Giovanni Ferreira from The Institute for Musculoskeletal Health and Sydney Musculoskeletal Health at the University of Sydney.

“Some pain medicines may have a role in pain management, but they need to be considered as only part of the solution. For some pain conditions, exercise, physiotherapy, and lifestyle changes may also help. Speak to your health professional to learn more about what alternatives might be appropriate for you,” Dr. Ferreira concludes.

The study is published in The BMJ.

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