Most antidepressants used for chronic pain are being prescribed with “insufficient” evidence of their effectiveness, scientists have warned. A major investigation into medications used to manage long-term pain has found that the harms of many of the commonly recommended drugs have not been well studied.
Published in the Cochrane Database of Systematic Reviews, the study led by scientists from several UK universities including Southampton and Newcastle, examined 176 trials consisting of nearly 30,000 patients involved in assessments which prescribed antidepressants for chronic pain.
Among the drugs studied were amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine—with only the latter showing reliable evidence for pain relief. One-third of people globally are living with chronic pain, World Health Organization data shows, with many prescribed antidepressants for relieving symptoms.
Lead author Professor Tamar Pincus from the University of Southampton said, “This is a global public health concern. Chronic pain is a problem for millions who are prescribed antidepressants without sufficient scientific proof they help, nor an understanding of the long-term impact on health.
“Our review found no reliable evidence for the long-term efficacy of any antidepressant and no reliable evidence for their safety for chronic pain at any point. Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence.”
Amitriptyline is one of the most commonly prescribed antidepressants for pain management worldwide. In the last 12 months; around ten million prescriptions were given to patients in England at the 10mg dose recommended for pain. By comparison, five million prescriptions were given at the higher doses recommended for depression.
For duloxetine, three and a half million prescriptions were dispensed in England, but the recommended doses do not currently differ between conditions.
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