A systematic review of studies on antidepressants for low back pain has shown that they are no more effective than placebo, but still could have even more serious side effects.
Explaining the study, lead author Michael Ferraro, doctoral candidate at University of New South Wales (UNSW) Medicine & Health and Neuroscience Research Australia (NeuRA), said: “Antidepressants are commonly prescribed to treat the symptoms of low back pain. However, prescription rates for antidepressants to manage low back pain are increasing worldwide, despite unclear evidence to support their efficacy and safety and conflicting advice in clinical guidelines.”
Across 17 studies with over 2500 participants, the researchers looked at differences in outcomes for pain, safety, function and depressive symptoms between people taking antidepressants and placebos.
“We found that treating low back pain with antidepressants failed to lead to reductions in what patients might consider important benefits for pain or function,” Mr Ferraro said.
“We also discovered that people taking antidepressants for low back pain are more likely to stop treatment and experience side effects and might even experience more serious side effects.
“If people are taking antidepressants for low back pain and have any concerns about their treatment, they should consult their medical physician for advice.”
These results bring into question no less than six international guidelines that recommend the use of antidepressants for low back pain. In particular, the US has a guideline for duloxetine, a serotonin and norepinephrine reuptake inhibitor, chronic low back pain treatment.
“We believe the US recommendation for duloxetine could be reconsidered in light of our findings,” he said. “Ongoing recommendations for the use of antidepressants to treat low back pain are concerning, particularly given the increased risk of side effects.”
The low quality of the studies in general limited their findings, but no clear benefits of using antidepressants for low back pain could be identified.
“It is difficult to estimate the true effects of such medicines being used to treat low back pain. The majority of the studies were considered to be at high risk of bias and interestingly, the studies which showed the most promise were industry-sponsored. We recommend future research focuses on other types of medicines that may provide benefit to adults with low back pain, as well as non-pharmacological treatments, such as physiotherapy and exercise,” said Mr Ferraro.
Source: News-Medical.Net
Journal information: Ferraro, M.C., et al. (2021) Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Systematic Reviews. doi.org/10.1186/s13643-021-01599-4.
