It’s clear antidepressants are not always effective for tackling chronic pain

Chronic pain has been treated with antidepressants for some time, the rationale being that while they don’t actually treat the pain, you mind it less.

This can be useful for patients with long-standing unremitting pain, but are antidepressants really that ­effective? This is an oft-asked question and Warwick University researchers have had a stab at answering it by bringing together the evidence from more than 150 trials into one report.

Make no mistake, chronic pain is a big problem and affects between a third and half of the UK population.

Now an international team of researchers, including academics from Warwick, has found that some types of antidepressants are effective in treating certain pain conditions while others are not.

Warwick’s Professor Martin ­Underwood, a co-author of the report, said: “There is a role for anti-depressants in helping people living with chronic pain, however, this is more limited than previously thought.

“Antidepressants may have unpleasant side effects that patients may wish to avoid. We need to work harder to help people manage their pain and live better, without relying on the prescription pad.”

The review included over 25,000 patients and data from eight types of antidepressant and 22 pain conditions covering back pain, fibromyalgia, headaches, postoperative pain and irritable bowel syndrome.

Serotonin-related antidepressants such as duloxetine were effective for the largest number of pain conditions, such as back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and neuropathic pain (nerve pain).

By contrast, older antidepressants such as amitriptyline are the most commonly used to treat pain, but it’s unclear how well they work – or whether they work at all.

Lead author Dr Giovanni Ferreira from Sydney University, Australia, said: “Recommending a list of anti-depressants without the careful ­consideration of evidence for each of those 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.”

Report co-author Dr ­Christina Abdel Shaheed, also from Sydney University, said: “The findings from this review 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.”

She believes painkillers are only part of the solution. There are many treatments for pain, and exercise, physio and lifestyle changes may also help.

Data from Canada, the US, the UK and Taiwan suggests that among older people, chronic pain is the most common condition leading to an antidepressant prescription, even more so than depression itself.