Prescribing antidepressants for chronic pain lacks evidence, experts say

Researchers have warned there is a lack of evidence around prescribing antidepressants for chronic pain.

Guidance from the National Institute for Health and Care Excellence (Nice) in 2021 recommends that an antidepressant (amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline) can be considered for people aged 18 and over with pain lasting longer than three months which cannot be accounted for by another diagnosis.

The guidance said the drugs may help with quality of life, pain, sleep and psychological distress, even if the patient is not suffering depression.

A separate guideline on neuropathic (nerve) pain recommends offering a choice of treatments, including amitriptyline and duloxetine, alongside a discussion on possible benefits and side-effects.

However, researchers writing in the BMJ have warned that recommending antidepressants for pain is not always backed by evidence.

Professor Martin Underwood from the University of Warwick, said: “There is a role for antidepressants 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.”

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Source: The Independent, 1 February 2023