Are antidepressants for chronic pain effective?

A more thoughtful approach to prescribing for pain needed.

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Chronic pain is common and debilitating, affecting about one in five people globally. Chronic pain can be challenging to treat, and management is often suboptimal. Antidepressants are frequently used for the treatment of chronic pain. The use of antidepressants to help manage a person’s pain is on the rise, even when they do not have a mood disorder like depression.

Are they effective?

An international team of scientists, led by the University of Sydney, provides a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition. They found some antidepressants may be effective in treating certain chronic pain conditions, but others lack convincing evidence of their effectiveness.

The review examined 26 systematic reviews from 2012 to 2022 involving over 25,000 participants. Over 25,000 people were involved in 26 systematic reviews from 2012 to 2022 that were the subject of the review. This contained information on 22 types of pain, and eight antidepressant classes, including back, fibromyalgia, headache, postoperative, and irritable bowel syndrome pain disorders.

Scientists noted, “The results show clinicians need to consider all the evidence before deciding to prescribe antidepressants for chronic pain management.”

Lead author Dr. Giovanni Ferreira from Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Local Health District, and Northern Sydney Local Health District, said, “This review, for the first time, brings together all the existing evidence about the effectiveness of antidepressants to treat chronic pain in one comprehensive document.”

The majority of pain problems, including back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and neuropathic pain (nerve pain), were shown to be successfully treated with serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants, such as duloxetine.

Contrarily, tricyclic antidepressants, including amitriptyline, are the most frequently prescribed antidepressants in clinical practice to treat pain. Still, the analysis revealed that it is uncertain whether or how effectively they function for most pain problems.

Ferreira said a more nuanced approach to prescribing antidepressants for pain is needed.

“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.”

Co-author Dr. Christina Abdel Shaheed from The School of Public Health and Sydney Musculoskeletal Health said:

“The findings from this review will support both clinicians and patients to weigh up the benefits and harms of antidepressants for various pain conditions so that they can make informed decisions about whether and when to use them.”

Dr. Ferreira said that there are multiple treatment options for pain, and people should not rely solely on pain medicines for pain relief.

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

Professor Christopher Maher, Co-Director of Sydney Musculoskeletal Health, said, “This review distilled the evidence from over 150 clinical trials into an accessible summary that clinicians can use to help them make better decisions for their patients with chronic pain.”

Journal Reference:

  1. Giovanni E Ferreira, Christina Abdel- Shaheed et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: an overview of systematic reviews. BMJ. DOI: 10.1136/bmj-2022-072415
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