One in five people worldwide live with it. Chronic painAnd that's a typical reason to see a health care provider, accounting One in five GP appointments within the UK.
With increasing caution about prescribing opioids — given their potential for addiction — many doctors are attempting to prescribe other drugs, “off-label,” to treat long-term pain. A well-liked option is antidepressants.
In the UK, doctors may prescribe the next antidepressants: “Chronic Core Pain” (Pain with no known underlying cause): amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine and sertraline. Amitriptyline and duloxetine are also really useful. Pain in the veinscorresponding to sciatica.
However, our Review Studies investigating the effectiveness of antidepressants within the treatment of chronic pain have found evidence for less than one in all these drugs: duloxetine.
We found 178 relevant studies with a complete of 28,664 participants. This is the biggest ever review of antidepressants for chronic pain and the primary to incorporate all antidepressants for all sorts of chronic pain.
Forty-three studies (11,608 people) investigated duloxetine. We found that it moderately reduced pain and improved mobility. It is the one antidepressant that we imagine has an effect. We also found that the 60 mg dose of duloxetine was as effective in relieving pain because the 120 mg dose.
In comparison, while 43 studies also investigated amitriptyline, the full variety of participants was only 3,372, indicating that the majority of those studies are small and liable to biased results.
Other antidepressants studies and participant numbers include:
-
Citalopram: five studies with 209 participants
-
Fluoxetine: 11 studies with 622 participants
-
Paroxetine: nine studies with 960 participants
-
Sertraline: three studies with 210 participants.
The evidence for amitriptyline, citalopram, fluoxetine, paroxetine and sertraline was very poor, and no conclusions could possibly be drawn about their ability to cut back pain.
This is especially vital since the prescribing data shows 15,784,225 prescriptions for amitriptyline. Last year. It is affordable to assume that a big portion of those could also be for pain relief because amitriptyline No longer recommended To treat depression.
It seems that tens of millions of individuals are taking antidepressants to treat pain though there isn’t any evidence of their effectiveness. compared, 3,973,129 duloxetine prescriptions. were released through the same period for depression and pain composites.
In light of our findings, which were published in May 2023, the UK's National Institute for Health and Care Excellence (NICE) recently updated its advice to doctors on the way to treat chronic pain.
Updated Good guidance Now prescribes duloxetine 60mg for treatment. [chronic primary pain] and the identical drug and dose to treat nerve pain.
Paul Mogford/Almy Stock Photo
Limited treatment options
GPs often report frustration. Limited options Available to them to treat patients experiencing chronic pain. Amitriptyline is affordable to prescribe – Only 66p per pack – which can explain the high variety of prescriptions for this drug.
This is an example of how the gap between evidence and clinical practice can harm patients. Although our review was unable to ascertain the long-term safety of antidepressant use, previous research has highlighted its high rates. Side effects of amitriptylineincluding dizziness, nausea, headache and constipation.
It's vital to take note, though, that pain is a really individual experience, and the evidence in our review is predicated on groups of individuals. We recognize that some medicines may fit for people even when research evidence is inconclusive or unavailable. If you have got any concerns about your pain medication, you must discuss it along with your doctor.