It comes as a surprise to many that antidepressants, traditionally used to help those dealing with depression, are increasingly being prescribed to help those dealing with chronic pain.
In Australia, like in the rest of the world, chronic pain affects one out of every five individuals. Despite the prevalence of this condition, the treatment of chronic pain is frequently ineffective, with many regularly prescribed medications having questionable or even harmful side effects.
Increasingly, people who do not have a mood illness like depression are turning to antidepressants as a means of pain management.
A multinational team of researchers discovered that certain kinds of antidepressants were useful in treating adult pain, whereas others were either ineffective or unknown.
The research, which was published in The BMJ, examined the efficacy and safety of antidepressants in the management of chronic pain.
According to the researchers who conducted the study, the findings demonstrate that doctors need to assess all of the data before determining whether or not to prescribe antidepressants for the treatment of chronic pain.
“This review,” according to Lead author Dr. Giovanni Ferreira, “for the first time, brings together all the existing evidence about the effectiveness of antidepressants to treat chronic pain in one comprehensive document.”
Over 25,000 people were analyzed throughout 26 systematic studies conducted between 2012 and 2022. This had information on 22 types of pain, eight antidepressant classes, including back, fibromyalgia, headache, postoperative, and irritable bowel syndrome pain disorders.
Antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRI), like duloxetine, were found to help with most types of pain, like back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and neuropathic pain (nerve pain).
Contrarily, tricyclic antidepressants, including amitriptyline, are the most often prescribed antidepressants in clinical practice to treat pain, but the analysis revealed that it is uncertain if or how effectively they function for the majority of pain problems.
Antidepressants are now getting more attention around the world as a way to treat pain. The National Institute for Health and Care Excellence (NICE) published a guideline for chronic primary pain management in 2021. The guideline says that pain medicines should not be used, except for antidepressants.
The guideline suggests that adults with chronic primary pain take antidepressants like amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline.
Antidepressant prescriptions for pain, according to Dr. Ferreira, need to take a more nuanced approach.
“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.”
“The findings from this review,” remarks co-author Dr. Christina Abdel Shaheed, “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 many ways to treat pain, and that people shouldn’t just take painkillers to feel better.
Although certain painkillers may help control pain, they should only be seen as a part of the solution. Exercise, physiotherapy, and dietary modifications may also be beneficial for certain types of pain issues. Speak with your healthcare provider to learn more about the choices that could be suitable for you, said Dr. Ferreira.
“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 adds.
Antidepressants in Australia and all over
Most prescriptions for antidepressants to treat pain are “off-label,” which means that antidepressants have not been approved to treat pain.
It is believed that many antidepressants alleviate pain by stimulating the production of serotonin and other chemicals in the brain that aid in pain management. However, the precise reason why certain antidepressants reduce pain is unclear. Duloxetine, which is licensed to treat diabetic neuropathic pain, is the only antidepressant in Australia that has been approved to treat pain (nerve pain caused by diabetes).
Amitriptyline is approved to treat a few types of pain in the UK, including neuropathic pain (nerve pain), tension-type headaches, and migraines, however it is not authorized in Australia to treat any kind of pain.
Between 2000 and 2015, the use of antidepressants more than quadrupled in OECD nations, and the use of ‘off-label’ prescriptions of antidepressants for pain is thought to be a major reason. According to data from Taiwan, the United States, Canada, the United Kingdom, and Taiwan, chronic pain is more often treated with antidepressants than depression among older individuals.
At the moment, there is no information from Australia about how many antidepressants are prescribed for pain.
Source: 10.1136/bmj-2022-072415
Image Credit: Getty