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About a third of people worldwide they live with chronic pain (pain experienced for more than three months) and millions of people are prescribed antidepressants to alleviate the condition.
However, a new review of previous research published Tuesday found that most antidepressants used to relieve chronic pain are prescribed without sufficient reliable evidence of their effectiveness. Furthermore, the potential harms have not been well studied.
A two year study by non-profit group Cochrane found that only one antidepressant, duloxetine, was effective for short-term pain relief based on the available evidence. Cochrane is an international collaboration of researchers that produces the Cochrane Library, which includes a database of systematic abstracts addressing key questions in healthcare.
Sold under the brand names Irenka and Cymbalta, duloxetine is a serotonin and norepinephrine reuptake inhibitoror SNRI, and also increases levels of the feel-good neurochemical dopamine.
“This is a global public health problem,” said lead author Tamar Pincus, a professor and chronic pain researcher at the University of Southampton in the United Kingdom.
“Chronic pain is a problem for millions of people who are prescribed antidepressants without sufficient scientific evidence that they help, nor an understanding of the long-term impact on health.”
The review included 176 studies with a total of 28,664 participants and looked at 25 different antidepressants. The studies mainly investigated three types of chronic pain: fibromyalgia, nerve pain and musculoskeletal pain.
The average study duration was 10 weeks, and the studies were randomized controlled trials, considered to be the gold standard in medical research. Seventy-two of the studies were funded by pharmaceutical companies.
The most frequently prescribed antidepressant for chronic pain globally was amitriptyline, according to the study. Sold in the United States under the brand names Elavil and Vanatrip, the antidepressant was approved in 1961 by the US Food and Drug Administration to treat depression in adults. The drug has significant side effects, so it’s not commonly used for depression, but it is prescribed to treat migraines and chronic pain such as diabetic neuropathy.
However, the authors found that most studies on the effectiveness of amitriptyline were small and the evidence unreliable.
milnacipran, which is FDA approved for fibromyalgiait was also effective in reducing pain, the review found, but scientists were not as confident in this drug compared with duloxetine due to limited studies with few people.
Anyone taking antidepressants for chronic pain relief should talk to their doctor before stopping their medication because of concerns about the new report, the authors emphasized.
Antidepressants are thought to help with pain because the body systems that regulate mood and pain overlap, explained Ryan Patel, a researcher who studies chronic pain at King’s College London’s Wolfson Center for Age-Related Diseases. .
He said the key question for researchers to answer was not whether antidepressant medications were effective in treating pain, but “for whom are antidepressants effective?”
“Even when the cause of chronic pain is the same, the biological changes that occur in the nervous system are varied, so it is not surprising that pain presents differently from person to person, and not everyone will respond to the same medications. “, said. Patel, who was not involved in the review.
“What this comprehensive analysis shows is that when clinical trials are poorly designed under the assumption that everyone’s pain experience is uniform, most antidepressants appear to have limited use in treating chronic pain,” Patel added in a statement.
Even for the antidepressant duloxetine, there was no research looking at long-term use of the drug, the review found.
“Although we found that duloxetine provided short-term pain relief for the patients we studied, we remain concerned about its potential long-term harm due to gaps in current evidence,” Pincus said.
The report said future research should address the unwanted effects of antidepressant use for chronic pain, noting that existing data on this was “poor”.
“(Duloxetine) looks really good right now for short-term pain relief, but I want to emphasize that patients are not prescribed duloxetine or any antidepressant for three weeks, four weeks, six weeks, they are prescribed for six months. So it’s really shocking that we don’t have any evidence for long-term use even of duloxetine,” Pincus said.
Dr Cathy Stannard, Clinical Director of the UK National Institute for Health and Care Excellence (NICE) Chronic Pain Guideline, and Pain Specialist at the Integrated Care Board of NHS Gloucestershire in the UK, said it was important to emphasize the social and psychological influences on how people experience pain and the importance of a patient’s relationship with their doctor.
“There is good evidence that for people in pain, compassionate and ongoing relationships with physicians remain the foundation of successful care,” Stannard, who was not involved in the research, said in a statement.
“Research shows that what people want most is a strong, empathetic relationship with their care provider. They want time to talk about what matters to them, and they want easy access to support and to be partners in their care.”
Non-pharmaceutical interventions such as mobility support, debt management, trauma and social isolation are also likely to help people living with pain, he added.
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