2023-05-11 09:56:26
Dubai, United Arab Emirates (CNN) — About a third of people worldwide suffer from chronic pain that lasts more than three months, and millions of people are prescribed antidepressants to relieve it.
A new review of previous research published on Tuesday found that the majority of antidepressants used to relieve chronic pain are prescribed without sufficient reliable evidence of their effectiveness. Its potential harm has not been well studied.
A two-year study conducted by the non-profit group Cochrane concluded that only one antidepressant, duloxetine, was effective for short-term pain relief, according to available evidence.
Cochrane is an international collaboration of researchers that produces the Cochrane Library, the latter’s database of methodological abstracts addressing key questions in healthcare.
Duloxetine, sold under the brand names Irenka and Cymbalta, is a serotonin and norepinephrine reuptake inhibitor, or SNRI, that boosts levels of the neurochemical dopamine.
“Chronic pain is a global public health concern,” said Tamar Pincus, lead author of the review, a professor and researcher in chronic pain at the University of Southampton in the UK.
“Chronic pain is a problem for the millions who are prescribed antidepressants without enough scientific evidence that they help them and without an understanding of their long-term impact on health,” she added.
There is no evidence of the effectiveness of the prescribed medication
The review included 176 studies with a total of 28,664 participants, and looked at 25 different antidepressants. The studies primarily looked at three types of chronic pain: fibromyalgia, neuropathic pain, and musculoskeletal pain.
The average study duration was 10 weeks, and the studies were randomized controlled trials, considered the gold standard in medical research. And 72 of the studies were funded by drug companies.
The study said that the most common antidepressant prescribed for chronic pain worldwide is amitriptyline. It is sold in the United States under the brand names “Elavil” and “Vanatrip”, two antidepressants approved for use in 1961 by the US Food and Drug Administration to treat depression in adults. The drug has significant side effects, so it is not commonly used to treat depression, but it is prescribed for migraines and chronic pain such as diabetic neuropathy.
However, the authors found that the majority of studies on the effectiveness of amitriptyline were small and that the evidence was not reliable.
The review found that milnacipran, which is approved by the U.S. Food and Drug Administration to treat fibromyalgia, was also effective in relieving pain, but scientists weren’t confident about this drug compared to duloxetine because of the limited studies that included a small number of people. the people.
The authors stressed that anyone taking antidepressants to relieve chronic pain should speak to their doctor before stopping the medication because of concerns addressed in the new report.
The pain is not uniform
Antidepressants are thought to help relieve pain because the body’s systems that regulate mood and pain are involved, says Ryan Patel, a research fellow who studies chronic pain at the Wolfson Center for Age-Related Disease at King’s College London.
He pointed out that the main question that researchers have to answer is not whether antidepressants are effective in treating pain, but rather “for whom are antidepressants effective?”
“Even when the cause of chronic pain is the same, the biological changes that occur in the nervous system are diverse, so it is not surprising that pain presents differently from person to person, and not everyone will respond to the same medications,” Patel, who was not involved in the review, said.
“What this comprehensive analysis shows is that when clinical trials are poorly designed on the assumption that everyone’s experience of pain is uniform, the majority of antidepressants appear to have limited use in treating chronic pain,” he added in a statement.
Long term use needs to be studied
The review found that even for the antidepressant duloxetine, there was no research looking at long-term use of the drug.
“Although we found that duloxetine relieved pain in the short term for the patients we studied, we remain concerned about its potential long-term harm due to gaps in the current evidence,” Pincus said.
The report pointed out that future research should address any unwanted effects of the use of antidepressants for chronic pain, noting that the data on this matter is “weak”.
Dr Cathy Stannard, clinical lead for NICE guidelines for chronic pain and a pain specialist with the NHS Gloucestershire Integrated Care Council in the UK, said it was important to emphasize the social and psychological effects, and how people feel. People with pain, and the importance of the patient’s relationship with his doctor.
“Research shows that what people want most is to build a strong, empathetic relationship with their carer. They want time to discuss what matters to them, they want easy access to support, and to be partners in their care.”
“Non-pharmaceutical interventions, such as mobility support, debt management, trauma, and social isolation, are more likely to help people in pain,” she said.
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