Antidepressant drugs do not provide any benefit for people with back and osteoarthritis pain, according to a review published.
Researchers led by Giovanni Ferreira at the University of Sydney, Australia, say their findings show the effects are too small to be worthwhile among people with back pain, but among those with osteoarthritis, they may be a small beneficial effect.
Research fellow Ferreira analysed published data from 33 randomised controlled trials involving more than 5,000 adults with low back or neck pain, sciatica, or hip or knee osteoarthritis, to investigate the effectiveness and safety of antidepressants for back and osteoarthritis pain compared with a placebo.
The researchers set a difference of 10 points on a 0- to 100-point scale for pain or disability as the smallest worthwhile difference between groups and results revealed that serotonin-norepinephrine reuptake inhibitors (SNRIs) reduced back pain after three months.
However, the effect was small, with an average difference of 5.3 points on the pain scale compared with placebo.
When analysing osteoarthritis, they found an average difference of 9.7 points on the pain scale when comparing SNRIs on with placebo. Low certainty evidence showed that tricyclic antidepressants (TCAs) were ineffective for back pain and related disability.
The researchers concluded that TCAs and SNRIs might reduce pain in people with sciatica, but they were unable to draw any firm conclusions.
Although the trials, many of which were sponsored by industry, were designed differently, and were of varying quality, the research team said they allowed for this in their analysis.
Despite several limitations in the study, the authors said the review was based on a thorough literature search with a prespecified threshold for clinical importance used in other reviews of treatments for back and osteoarthritis pain.
This means their review updates the evidence for back pain, sciatica, and osteoarthritis, and could help clinicians and their patients decide whether to take antidepressants for chronic pain, although they acknowledged that large, definitive randomised trials, free of industry ties, are urgently needed.
Ferreira G E, MacLachlan A J, Lin C C et a. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis. BMJ 21 January 2021
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