Scientists warn that antidepressants used for chronic pain lack evidence of effectiveness.
- Largest ever investigation into antidepressants used for chronic pain shows insufficient evidence to determine how effective or harmful they may be
- Study reviewed commonly prescribed medications including amitriptyline, duloxetine, fluoxetine, citalopram, paroxetine, and sertraline
- One third of people globally are living with long-term pain with many prescribed antidepressants to relieve symptoms
Newswise — Scientists have cautioned that the prescription of most antidepressants for chronic pain is being done without sufficient evidence to support their effectiveness.
An extensive inquiry into medications utilized to manage chronic pain has discovered that the adverse effects of numerous drugs that are regularly recommended have not been adequately researched.
The Cochrane analysis, spearheaded by researchers from various UK universities such as Southampton and Newcastle, scrutinized 176 trials encompassing nearly 30,000 patients who underwent evaluations involving the prescription of antidepressants for chronic pain.
The medications that were examined included amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine, with only the latter demonstrating dependable proof for alleviating pain. According to data from the World Health Organization, around one-third of the global population is afflicted with chronic pain, with numerous individuals being recommended antidepressants for symptom relief.
Professor Tamar Pincus, the lead author of the study from the University of Southampton, stated, "This is a significant public health issue on a global scale. Chronic pain affects millions of people who are prescribed antidepressants without adequate scientific evidence of their efficacy or an understanding of the potential long-term health consequences."
"Our analysis did not reveal any dependable proof of the long-term effectiveness of any antidepressant nor did it provide reliable evidence of their safety for chronic pain management at any stage. While we did discover that duloxetine offered short-term pain relief to the patients we studied, we remain apprehensive about its potential long-term adverse effects due to the gaps in existing evidence," stated the professor as the lead author.
Amitriptyline is among the most frequently prescribed antidepressants for pain management on a global level. In the last 12 months, roughly ten million prescriptions were dispensed to patients in England for the 10mg dose that is suggested for pain management. In comparison, five million prescriptions were issued for the higher doses that are recommended for depression.
Regarding duloxetine, there were approximately three and a half million prescriptions dispensed in England, and currently, there is no difference in the recommended doses between conditions.
The Cochrane review, which spanned two years, was the most extensive evaluation ever conducted of antidepressants recommended by top organizations such as the UK's National Institute for Health and Care Excellence (NICE) and the US Food and Drug Administration (FDA).
Gavin Stewart, a statistician and co-author of the review from Newcastle University, stated, "We urge the governing health bodies such as NICE and the FDA to revise their guidelines to align with the new scientific evidence, and request funders to discontinue supporting small and defective trials. While evidence synthesis can be intricate and intricate, the evidence that supports the use of these therapies is not uniform, making it difficult to rationalize current treatment strategies."
The analysis demonstrated that duloxetine was consistently rated as the most effective medication and was equally efficacious for treating fibromyalgia, musculoskeletal, and neuropathic pain conditions.
Other results showed:
- Standard doses of duloxetine are as successful for reducing pain as higher quantities,
- Milnacipran was also effective at reducing pain, but scientists are not as confident as duloxetine due to fewer studies with fewer people.
Professor Tamar Pincus also stated, "We cannot draw conclusions about the other antidepressants since there is insufficient reliable evidence available. However, this does not imply that individuals should discontinue taking their prescribed medication without first consulting with their general practitioner."
The researchers who conducted the review were from various universities, including the University of Southampton, Newcastle University, University of Bristol, University College London (UCL), University of Bath, Keele University, and Oxford University Hospital. The research was funded by the National Institute for Health Research's (NIHR) Health Technology Assessment program.
The team employed a statistical approach that allows researchers to combine data from pertinent studies to estimate the impact of various medications that have not been directly compared in individual trials. This method is known as network meta-analysis.
Dr Hollie Birkinshaw, a researcher at the University of Southampton, remarked, "While previous research suggests that certain antidepressants may alleviate pain, there has never been a comprehensive study examining all medications across all chronic conditions until now."
Dr. Hollie Birkinshaw further stated, "The sole trustworthy evidence indicates that duloxetine is effective. It is crucial to take a person-centered approach to treatment, and if patients and healthcare professionals mutually decide to explore antidepressants, they should begin with the medication with reliable evidence."
The Cochrane review can be read at http://dx.doi.org/10.1002/14651858.CD014682.pub2.
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