Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews (1 February 2023)

Summary

Chronic pain is common and debilitating, affecting about one in five people globally. However, chronic pain can be difficult to treat, and management is often suboptimal.

The 2021 National Institute for Health and Care Excellence guideline for chronic primary pain explicitly recommends against the use of pain medicines, with the exception of antidepressants. To provide patients and clinicians with an updated and comprehensive resource on the efficacy, safety, and tolerability of antidepressants to treat pain, Ferreira et al. conducted an overview of relevant systematic reviews. 

The study found no review could provide high certainty evidence on the effectiveness of antidepressants for pain for any condition.

Nine reviews did provide evidence that some antidepressants were effective, such as moderate evidence suggesting serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine, were effective for back pain, post-operative pain, fibromyalgia and nerve pain.

However, the study only found low certainty evidence that selective serotonin reuptake inhibitors (SSRIs) were effective for people with depression and pain related to other conditions, and that tricyclic antidepressants (TCAs) were effective for irritable bowel syndrome, nerve pain and chronic tension-type headaches.

The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions.