Doctor with pill bottle, spilling medication into hand

With the exception of duloxetine, there is not enough reliable evidence of efficacy or safety to support the use of most antidepressant medications in the relief of chronic pain, a new review and meta-analysis of studies has found.

An implication for clinical practice is that an individualized approach is key to proper care when considering pain treatments, investigators wrote.

The review examined 176 trials representing nearly 30,000 patients who were prescribed antidepressants for chronic pain. Drugs studied included amitriptyline (the most commonly prescribed antidepressant for pain relief worldwide), fluoxetine, citalopram, paroxetine, sertraline and duloxetine. 

“Our review found no reliable evidence for the long-term efficacy of any antidepressant, and no reliable evidence for their safety for chronic pain at any point,” Professor Tamar Pincus from the University of Southampton in the U.K. reported. 

Duloxetine alone appeared to provide short-term pain relief at a standard dose of 60 mg, with no benefit associated with a higher dose. The authors said they are uncertain about possible long-term harm from duloxetine due to the gaps in current evidence. This drug may be considered before trying other antidepressants for pain, they advised.

“Adopting a person-centered approach is critical to treatment, and when patients and clinicians decide together to try antidepressants they should start from the drug for which there is good evidence,” they concluded.

In the United States, new cases of chronic pain are more prevalent than those of other common health conditions such as diabetes and hypertension, another recent study has found. New federal data show that 21% of the adult population live with chronic pain.

The study was published in Cochrane Reviews.

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