PainRelief.com: What are the main findings?
Response: We found moderate evidence only for one antidepressant, duloxetine, which consistently had the best evidence for pain relief and improved function. It was equally effective in standard dose and high dose, and the effect was consistent for the three conditions for which there was good evidence: neuropathic pain, fibromyalgia, and musculoskeletal pain. Another antidepressant, milnacipran, had promising evidence, but not enough to be certain of its effectiveness. There was insufficient evidence for all other antidepressants, including amitriptyline.
There was also no evidence on long term use of any antidepressant. On average trials lasted 10 weeks. Finally, and across all trials, report of side effects was poor.
PainRelief.com: What should readers take away from your report?
Response: The state of evidence for prescribing antidepressants for pain management is poor. If patients and doctors want to try antidepressants they should consider starting from duloxetine because it has the most consistent evidence.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: There is an urgent need for large, better trials in this area, that last longer and carefully monitor side effects.
Any disclosures? Funded by HTA and supported by the Cochrane, thus not for profit. None of the research team have been supported by pharma.
Birkinshaw H, Friedrich CM, Cole P, Eccleston C, Serfaty M, Stewart G, White S, Moore RA, Phillippo D, Pincus T. Antidepressants for pain management in adults with chronic pain: a network meta‐analysis. Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD014682. DOI: 10.1002/14651858.CD014682.pub2. Accessed 11 May 2023.
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