Evidence for Efficacy of Antidepressants for Pain Is Limited

In 11 comparisons, antidepressants were efficacious, but they were inefficacious or evidence was inconclusive for 31 comparisons

HealthDay News — Evidence for the efficacy of antidepressants for pain is limited and often inconclusive, according to research published online February 1 in The BMJ.

Giovanni E. Ferreira, PhD, from the University of Sydney, and colleagues conducted an overview of systematic reviews comparing any antidepressant with placebo for any pain condition among adults to examine the efficacy, safety, and tolerability of antidepressants for pain. Data were included from 26 reviews (156 unique trials and >25,000 participants). These reviews reported on the efficacy of 8 antidepressant classes and covered 22 pain conditions (42 comparisons).

The researchers found that none of the reviews provided high-certainty evidence for the efficacy of antidepressants for pain for any condition. Antidepressants were found to be efficacious in 11 comparisons (9 conditions), including 4 with moderate-certainty evidence: serotonin-norepinephrine reuptake inhibitors for back pain, postoperative pain, and neuropathic pain (mean difference, −5.3, −7.3, −6.8, respectively) and fibromyalgia (risk ratio, 1.4). In the remaining comparisons, antidepressants were not efficacious (5 comparisons) or the evidence was inconclusive (26 comparisons).

“Ferreira and colleagues’ overview adds to mounting evidence challenging the use of medicines for pain. In consequence, a real opportunity is emerging to focus more on what living with pain means for individuals and to change how we think about pain,” write the authors of an accompanying editorial.

Several authors disclosed financial ties to the biopharmaceutical and medical technology industries.

Abstract/Full Text