Study finds antidepressants may have limited role in managing back pain and osteoarthritis

Antidepressants have become a treatment of choice for many chronic pain conditions, including back and osteoarthritis. In fact, antidepressants are the fourth most prescribed medication low in United States. But according to new study published BMJ January 2021, evidence may not add up their use treating certain conditions. systematic review meta-analysis, researchers found that limited role managing “We were surprised that, pain, either ineffective or had very small beneficial effects [SNRIs only] disability,” said Ferreira, lead author. “This is stark contrast with fact guidelines recommend use.” The American College Physicians, example, recommends SNRI duloxetine pain; Rheumatology this management, as well. also SNRIs offered small, nonclinically relevant benefits people Their questioned tricyclic sciatica, certainty was these medications might provide clinically important benefits. “In our review, only statistically significantly increased risk adverse events. However, number studies evaluating safety other antidepressant classes trials underpowered detect harm, ranged from low,” authors wrote. Because range well-known effects, pharmacists crucial ensuring patients well-informed about harms so they can make an informed decision whether take Ferreira said. showed two-thirds using experienced accompanying editorial, Underwood Tysall wrote, need work harder help disorders live better without recourse prescription pad.” goal conduct high-quality update on They realized data reviews outdated methodological problems did allow comprehensive assessment pain. yielded consistent findings based evidence, results. “The estimates quite precise, which increases confidence do pain,” Ferreira. Also know all testing efficacy industry funded, Even under circumstance, he said, patients. “I say because there industry-funded tend report bigger effect sizes relation conducted by independent investigators,” contrast, sciatica much poorer quality. All poor methods. “Although we find some antidepressants, particularly tricyclics, uncertain, could firm recommendation [for against use],”