Antidepressants prescribed for chronic pain have no reliable evidence of efficacy or safety. « Medicine in the Library

Most antidepressants used for chronic pain are being prescribed with “insufficient” evidence of their effectiveness, scientists have warned.

A major survey of drugs used to manage long-term pain found that the harms of many of the commonly recommended drugs have not been well studied.

The Cochrane reviewled by scientists from several British universities including Southampton and Newcastle, looked at 176 studies comprising nearly 30,000 patients involved in evaluations prescribing antidepressants for chronic pain. The two-year Cochrane study was the largest ever evaluation of antidepressants.

Among the drugs studied were amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine; only the latter shows reliable evidence for pain relief. Indeed, the review revealed that duloxetine it was consistently the highest-scoring drug and was equally effective for fibromyalgia, musculoskeletal and neuropathic pain conditions.

Professor Tamar Pincus from the University of Southampton, said: “This is a global public health concern. Chronic pain is a problem for millions of people who are prescribed antidepressants without enough scientific evidence that they help, nor an understanding of the long-term impact on health“.

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Antidepressants for pain management in adults with chronic pain: a network meta‐analysis.
Birkinshaw H, Friedrich CM, Cole P, Eccleston C, Serfaty M, Stewart G, White S, Moore RA, Phillippo D, Pincus T.
Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD014682. DOI: 10.1002/14651858.CD014682.pub2. Accessed 10 May 2023. PMID: 37160297

Source: University of Southampton