Ongoing pain, such as chronic back or neck pain, is difficult to treat, so some doctors prescribe antidepressants. Now, a review of evidence says these drugs mostly don't work as a treatment
Ferreira and his colleagues have now conducted a detailed breakdown of the supporting evidence, analysing the results of 156 randomised trials involving more than 25,000 participants. They looked at the effectiveness of eight types of antidepressant at treating 22 pain conditions, such as back pain, postoperative pain and fibromyalgia, where people have widespread muscular pain.
The one class that did have evidence of effectiveness was a kind called serotonin and norepinephrine reuptake inhibitors, or SNRIs. But even these reduced pain by a modest amount: less than 10 points on a scale of 0 to 100. “It seems to be a small difference,” says Ferreira. Asking people to subjectively rate their pain on a numerical scale is the only way to gauge its extent, which makes diagnosis and treatment of pain all the harder.
, which said antidepressants were the only class of medicines that doctors should consider for chronic pain, although this should only be after discussing the potential benefits and harms. The difference in conclusions may be because the latest analysis included more trials and considered each pain condition separately, says Ferreira.
But there is unlikely to be any pharmacological “magic bullet” for chronic pain, says Stannard. Doctors and people in pain should consider exploring other options, such as specialist group exercise classes or trying to tackle other difficulties in their life, like job stress or social isolation, which can amplify the impact of long-term painful conditions, she says.
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