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Are antidepressants also relieving pain? – Harvard Health Blog

Are antidepressants also relieving pain?  – Harvard Health Blog

Did you know that antidepressant medications are prescribed to people without depression?

It’s true. Antidepressants are often prescribed for chronic pain, especially pain associated with nerve disease (called neuropathic pain), chronic back or neck pain, and certain types of arthritis.

In fact, there are some guidelines for treating chronic back pain and osteoarthritis (the most common type of arthritis) are antidepressants. One antidepressant in particular, duloxetine (Cymbalta), has been approved by the FDA for these conditions.

Simply how antidepressants reduce pain is not well understood. One possibility is that they affect the brain chemicals involved in the perception of pain compared to the way we deal with depression.

It is usually not the first option to relieve pain

For people with chronic back or neck pain or hip or knee osteoarthritis, antidepressant medication is not usually the first treatment recommended. Other approaches such as physical therapy, exercise, weight loss, steroid anti-inflammatory drugs (NSAIDs) or cortisone injections are usually tried first. But if these are not helpful, antidepressants like duloxetine or amitriptyline may be a reasonable next step.

When prescribed for pain, the initial dose is usually low (usually lower than the initial dose of depression). If necessary, it has gradually increased. Ideally, people notice the advantage within a few weeks of starting the medication, and the medication can be continued at the lowest effective dose. Switching to a different antidepressant is recommended if the pain is not well controlled, if side effects occur, or if you are interacting with another medication.

A new study suggests that antidepressants do not work well for common types of pain

Studies on antidepressants against chronic pain, for example duloxetine for osteoarthritis of the knee, amitriptyline or duloxetine for chronic back pain, and amitriptyline for chronic neck pain, has shown a modest short-term benefit. But the research was limited: most of the trials were small and lasted a few months or less. In particular, medication side effects, such as nausea, constipation, and erectile dysfunction, were common in these tests.

Now 2021 study has combined data from past research to better understand how safe and effective antidepressants are for these conditions. The news is not good:

  • On average, antidepressant treatments reduced pain and disability at least compared to placebo. The improvement in pain – about 4 points on a scale of 0 to 100 – was considered too small to be noticeable.
  • People treated with some antidepressants for chronic pain often stopped taking medication because it didn’t work, because the side effects were unacceptable, or both.
  • People with chronic pain and depression have not had more improvement than those with chronic pain alone.

Sciatica can be an exception: antidepressants can reduce pain for a year. However, the quality of previous research was poor, so the authors of the study were not sure of these conclusions.

These findings call into question the usefulness of antidepressant treatment for common causes of chronic pain. However, they do not rule out that some people may receive more relief from these medications than others.

Bottom line

The available evidence suggests that, on average, antidepressants with osteoarthritis or chronic back pain and neck pain are modest at best, and are usually temporary. This is disappointing because for many people with pain there is no reliable effective treatment (a short replacement for osteoarthritis joints).

So if you have an antidepressant for pain and are not sure if it works, talk to your doctor to find out if you should think about stopping it. But don’t stop on your own. There may be other reasons your doctor recommends this medication, and many antidepressants should be reduced, not stopped at once, to prevent symptoms of discontinuation.

If you are taking an antidepressant depression, it is worth doing something for you again and it may be time to shorten your list of medications. In addition to simplifying your medical regimen, you can reduce the cost of medications and the risk of side effects associated with medications.

Follow me on Twitter @RobShmerling

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