Antidepressants Offer No Significant Benefit for Managing Low Back Pain

March 8, 2021

A new systematic review led by UNSW Sydney has found that treating low back pain with antidepressant drugs has no significant benefit and has the potential to cause harm.

Low back pain affects millions of Australians each year and is responsible for most of the years lived with a disability worldwide.

The most common treatments used for low back pain are drugs that aim to reduce the pain.

Often, people with low back pain are prescribed antidepressants when other drugs such as ibuprofen or paracetamol do not provide relief.

The new study, published in Systematic reviews recently consolidated the results of 17 studies involving more than 2,500 adult participants.

The researchers compared the results of five different classes of antidepressant drugs with the use of placebos.

Antidepressants are commonly prescribed to treat symptoms of low back pain. However, rates of prescription of antidepressants for the management of low back pain are increasing worldwide, despite unclear evidence to support their efficacy and safety and conflicting advice in clinical guidelines. “

Michael Ferraro, senior author, doctoral student at UNSW Medicine & Health and Neuroscience Research Australia (NeuRA)

The research team investigated differences in pain, safety, function, and depressive symptoms between people taking antidepressants and placebos.

Mr Ferraro said: “We have found that treating low back pain with antidepressants does not reduce what patients might see as important pain or function benefits.

“We also found that people taking antidepressants for low back pain are more likely to stop treatment and experience side effects, and may even experience more serious side effects.

“If people are taking antidepressants for low back pain and have concerns about their treatment, they should see their doctor for advice.”

Results challenge clinical guidelines

The study results call into question six international guidelines that recommend the use of antidepressant drugs for chronic low back pain.

In particular, the United States guideline approves duloxetine, a serotonin and norepinephrine reuptake inhibitor, for the treatment of chronic low back pain.

Mr. Ferraro and his colleagues, however, found no significant analgesic effects associated with the use of duloxetine or any other class or dose of antidepressant drugs.

“We believe that the US recommendation for duloxetine may be reconsidered in light of our results,” he said.

“The current recommendations for the use of antidepressants to treat low back pain are cause for concern, especially given the increased risk of side effects.”

More research is needed

Although the researchers found no significant benefit for treating low back pain with antidepressants, they recognized that the low quality of the studies reviewed in their systematic review limited the certainty of their results.

It is difficult to estimate the true effects of these drugs used to treat low back pain. The majority of studies were considered to be at high risk of bias and, interestingly, the most promising studies were funded by industry. We recommend that future research focus on other types of drugs that may provide benefit to adults with low back pain, as well as non-pharmacological treatments, such as physiotherapy and exercise. “

Michael ferraro