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A study published by the British Medical Journal (BMJ) provides evidence that stimulant medications are generally inadequate for back pain and osteoarthritis, although they are widely used for these conditions.
The results, based on moderate-certainty evidence, show that for people with back pain the effects were too small to be worth it, but for osteoarthritis a small beneficial effect cannot be ruled out.
Most clinical practice guidelines recommend antidepressants for long-term (chronic) back pain and osteoarthritis of the hip and knee, but the evidence to support their use is uncertain.
To fill this knowledge gap, researchers led by Giovanni Ferreira of the University of Sydney set out to study the effectiveness and safety of antidepressants for back pain and osteoarthritis compared to a placebo.
Their findings are based on an analysis of published data from 33 randomized controlled trials involving more than 5,000 adults with lower back or neck pain, sciatica or osteoarthritis of the hip or knee.
The trials were designed differently and were of varying quality, but the researchers were able to factor this into their analysis. Most of the data came from industry sponsored trials.
The researchers defined a 10-point difference on a 0-100 point scale for pain or disability as the smallest valid difference between the groups – a cutoff commonly used in other studies of chronic pain.
The results showed that serotonin-norepinephrine reuptake inhibitors (SNRIs) reduced back pain after three months. But the effect was small – an average difference of 5.3 points on the pain scale from placebo – and unlikely to be considered clinically important by most patients.
For osteoarthritis, they found a slightly stronger effect of SNRIs on pain after three months – an average difference of 9.7 points on the pain scale compared to placebo – meaning a valid effect could not be ruled out.
Low-certainty evidence has shown that tricyclic antidepressants (TCAs) are ineffective for back pain and associated disabilities.
Tricyclic antidepressants and SNRIs may reduce pain in people with sciatica, but the evidence was not certain enough to draw firm conclusions.
The researchers recognize several limitations, including the possibility of missing trials and not being able to explore a dose-response relationship for most antidepressants due to the small number of studies across six different classes of antidepressants.
Nevertheless, the review was based on an extensive literature search with a pre-specified threshold for clinical significance used in other reviews of treatments for back pain and osteoarthritis.
As such, they say their review sheds light on the evidence for back pain, sciatica, and osteoarthritis, and could help clinicians and their patients decide whether to take antidepressants for chronic pain.
But they conclude: “Large definitive randomized trials, free of any industrial link, are urgently needed to resolve the uncertainties about the efficacy of antidepressants for sciatica and osteoarthritis highlighted by this review.”
In a linked editorial, researchers at the University of Warwick call for clearer guidance to inform a consistent approach to the use of antidepressants for people with pain conditions.
They recognize that some patients might choose to try antidepressants for a small chance of reducing pain after three months.
Overall, however, they claim that drug treatments are largely ineffective for back pain and osteoarthritis and can cause serious harm.
This story was posted from an agency feed with no text editing.
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