2023-05-11 20:06:00
Certain antidepressants are frequently prescribed for the treatment of chronic pain. But most are prescribed without sufficient evidence of their effectiveness, according to an analysis published in May 2023 in the journal Cochrane Library.
And, the harmful effects of many of those commonly recommended have not been well studied, the researchers report.
The study, “which spanned two years, is the largest ever evaluation of antidepressants recommended by leading organizations, including the National Institute for Health and Care Excellence (NICE) of the United Kingdom and the Food and Drug Administration (FDA) of the United States
».
The study, led by researchers from several UK universities including Southampton and Newcastle, looked at 176 trials including nearly 30,000 patients who were prescribed antidepressant drugs for chronic pain.
Among the antidepressants studied are amitriptyline (Elavil, Laroxyl, Endep…), fluoxetine (Prozac), citalopram (Séropram, Celexa), paroxetine (Deroxat, Paxil, Seroxat…), sertraline (Zoloft), duloxetine (Cymbalta…) and milnacipran (Ixel, Savella).
« Our study found no reliable evidence for the long-term effectiveness of any antidepressant, or its safety for chronic pain at any time.
”, reports Tamar Pincus of the University of Southampton, lead author. “Although we found that the duloxétine (Cymbalta…) provided short-term pain relief in the patients we studied, we remain concerned regarding its possible long-term harm due to gaps in the current evidence.
»
L’amitriptyline (Elavil, Laroxyl…) is one of the most commonly prescribed antidepressants in the world for the treatment of pain. Over the past 12 months, approximately 10 million prescriptions have been dispensed to patients in England for the recommended dose of 10mg for the treatment of pain. By comparison, 5 million prescriptions were dispensed at the higher doses recommended for depression.
For the duloxétine (Cymbalta…)3.5 million prescriptions have been issued in England, but the recommended doses do not currently differ according to the pathologies.
The duloxétine (Cymbalta…) was consistently the drug with the best efficacy and was also effective for fibromyalgia, musculoskeletal pain, and neuropathic pain. Standard doses of duloxetine are as effective in reducing pain as higher doses.
The milnacipran (Ixel, Savella) was also effective in reducing pain, but researchers aren’t as confident as duloxetine because there are fewer studies and fewer people.
« We simply can’t comment on other antidepressants because we don’t have good enough studies – but that doesn’t mean people should stop taking the medicines they are prescribed without consulting their GP.
says Pincus.
« The only reliable evidence concerns the duloxétine (Cymbalta…). Taking a person-centered approach is essential to treatment, and when patients and clinicians decide together to try antidepressants, they should start with the drug for which there is good evidence.
»
« We call on health organizations NICE and FDA to update their guidelines to reflect new scientific evidence, and on funders to stop supporting small and flawed trials
concludes Gavin Stewart of the University of Newcastle, co-author.
Another analysis, covering 156 clinical trials and 25,000 participants, was published in February 2023 in the British Medical Journal. The authors concluded that, for most people living with chronic pain, treatment with antidepressants will be disappointing.
For more information, see the links below.
Psychomedia with sources: Cochrane Library, University of Southampton.
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