A new study reveals the best antidepressant for treating pain conditions such as fibromyalgia, musculoskeletal, and neuropathic pain.
Before starting antidepressants for pain relief, a recent study suggests there are important factors to consider.
Health experts warn that many commonly prescribed antidepressants for chronic pain lack sufficient evidence of their efficacy and potential adverse effects.
The Cochrane review, conducted by a team of scientists from various UK universities, including Southampton and Newcastle, analyzed 176 trials involving nearly 30,000 patients who received antidepressants for chronic pain relief. The study evaluated drugs such as amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine, with only the last drug demonstrating reliable evidence for pain alleviation.
Given that approximately one-third of people worldwide suffer from chronic pain, according to data from the World Health Organisation, the findings underscore the importance of evaluating the potential benefits and risks of antidepressants for pain relief before prescribing them.
“This is a global public health concern,” points out lead author Professor Tamar Pincus.
“Chronic pain is a problem for millions who are prescribed antidepressants without sufficient scientific proof they help, nor an understanding of the long-term impact on health.
“Our review found no reliable evidence for the long-term efficacy of any antidepressant, and no reliable evidence for their safety for chronic pain at any point. Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence.”
Amitriptyline, a commonly prescribed antidepressant, is widely used for pain management at a recommended dose of 10mg. In England, around ten million prescriptions have been issued for this purpose in the past year. Conversely, higher doses of Amitriptyline, recommended for depression, saw five million prescriptions.
In contrast, duloxetine garnered approximately three and a half million prescriptions in England, with recommended doses remaining consistent for depression and pain management.
This comprehensive study, endorsed by leading healthcare organizations such as the UK’s National Institute for Health and Care Excellence (NICE) and the US Food and Drug Administration (FDA), spans two years and is the largest evaluation of antidepressants to date.
The review highlights duloxetine as consistently ranking highest among the assessed medications, demonstrating comparable efficacy in treating pain conditions such as fibromyalgia, musculoskeletal, and neuropathic pain.
Further research has indicated that:
- Duloxetine is equally effective in pain reduction at standard doses as it is at higher doses.
- Milnacipran has also demonstrated success in reducing pain; however, due to a smaller number of studies involving fewer participants, there is less certainty when compared to duloxetine.
“We simply cannot tell about other antidepressants,” adds Prof Tamar Pincus, “because sufficiently good studies are not available – but it does not mean that people should stop taking prescribed medication without consulting their GP.”
By utilizing a statistical method, the researchers were able to combine data from relevant studies and assess the effects of different drugs that had not been directly compared in individual trials.
“Though previous investigations show that some antidepressants might relieve pain, there has never been a comprehensive study examining all medications across all chronic conditions – until now,” points out University of Southampton researcher Dr. Hollie Birkinshaw.
“The only reliable evidence is for duloxetine. Adopting a person-centred approach is critical to treatment, and when patients and clinicians decide together to try antidepressants they should start from the drug for which there is good evidence.”
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