‘Shocking’ lack of evidence on antidepressants for chronic pain

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By Michelle Roberts, Digital Health Editor

49 minutes ago

Image source, Getty Images

A large review found that people with chronic pain are given antidepressants with little scientific evidence that the medication helps them.

In studies of nearly 30,000 patients, there was “moderate” evidence for only one drug, duloxetine, and for only short-term pain relief.

And there was a “shocking” lack of long-term data, even though the pills are usually prescribed for several months.

But he advises patients to stay on medication if it’s working for them.

Experts say they shouldn’t suddenly stop taking the pills without talking to a doctor.

Antidepressants may be used for some chronic pain conditions, including nerve pain and fibromyalgia. Try psychological therapies such as cognitive behavioral therapy (CBT)

Chronic pain, lasting more than three months, is extremely common – a BBC News study suggests one in four people in the UK live with it.

There can be no clear cause – or it may be related to other health conditions, such as arthritis.

Experts say the brain systems for mood and pain overlap greatly, which is why it has been suggested that antidepressants may help. Hundreds of thousands of patients with chronic pain in the UK are believed to suffer from it.

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The Cochrane review, which was led by scientists from several British universities, including Southampton and Newcastle, examined 176 trials. But most looked at patients’ experience over just two months.

Of the drugs studied — which included Prozac and a cheap antidepressant called amitriptyline — only one, called duloxetine, showed any evidence of pain relief.

None of the trials collected long-term safety and efficacy data, which researchers say is shocking and needs treatment to guide patients and doctors.

Professor Tamar Pincus said: “It’s really appalling that we don’t have any evidence of even long-term use of duloxetine.

“This is a global public health concern. Chronic pain is a problem for the millions who are prescribed antidepressants without enough scientific evidence to help them, and no understanding of the long-term impact on health.

“But this does not mean that people should stop taking prescribed medications without consulting their GP.”

Dr Cathy Stannard, clinical lead for the National Institute for Health and Care Excellence (NICE) guidelines, said: “This well-conducted review adds to the substantial evidence we now have showing that the use of medications to treat long-term pain is disappointing.”

But it can be difficult to translate results from clinical trials into real life.

“Equally important is the emphasis on the many social and psychological influences on the experience of pain,” said Dr. Stannard.

“Existing services, typically outside healthcare, including mobility support, debt management, trauma and social isolation, can be helpful for people in pain – and identifying what matters most to people and making signals to appropriate local supports is a promising way forward. ”

When coming off an antidepressant, the medication should be tapered off slowly over a period of weeks to prevent withdrawal symptoms, says the NHS.

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