Study finds one antidepressant out of 25 can help treat chronic pain

Review included looking at 176 studies that involved 28,664 people and 25 separate antidepressants

ISLAMABAD, (Online) - New research by the Cochrane Database of Systematic Reviews has found that one antidepressant, duloxetine, has the potential to be used to help treat chronic pain.

The review included looking at 176 studies that involved 28,664 people and 25 separate antidepressants.

Of those, only duloxetine was found to have any kind of notable impact on chronic pain.

Potential to manage pain without opioids

The chronic pain conditions that researchers saw most often were fibromyalgia, neuropathic pain, and musculoskeletal pain.

Among the 25 antidepressants studied only duloxetine a type of selective norepinephrine reuptake inhibitor (SNRI) was effective at diminishing pain.

Researchers found that in a sample size of 1000, 435 individuals or about 43% would see their pain cut in half. Comparatively, the researchers found that just 287 or 28.7% of people would see the same amount of pain relief if they were taking a placebo.

The researchers describe duloxetine’s effect as “moderate” and also found that a higher dose than the standard 60 milligrams did not change how much of an effect was felt by study participants.

The average length of the studies researched was about ten weeks, as a result the researchers were unable to determine whether duloxetine—or any other antidepressant that is regularly prescribed—could provide pain relief in the long term.

Study could potentially help cut down on excess prescriptions

Dr. Christine Gibson (MD) says that the research has the potential to help, especially when it comes to managing people’s pain without the use of opioids.

Gibson said many times people in chronic pain end up being prescribed medications off-label and that many of these drugs can have side effects.

“I don’t find all of these tolerable to folks,” Gibson said. “And whenever I can, I’m deprescribing, so it’s nice to know that there was a reasonable efficacy.”

Gibson also says that, in her experience, people are often on many other medications before they get a duloxetine prescription. Gibson said it is important that physicians think about the mental and financial impacts of prescribing so many medications for people with chronic pain. “By the time people get to duloxetine, for me, they’re usually taking like eight pills a day, or 30 pills a day. Like, it’s not a small burden of pills,” Gibson said. “And I’m just really curious about the experience of folks who have pain, and they’re trying all the things…you’re going to try the NSAIDs. you’re going to try the Tylenol and then you’ll add duloxetine.”

Study looked at chronic pain, not mental health conditions

Dr. Mirela Loftus (MD, PhD) of Newport Healthcare says she would have liked to see how these medications also impacted chronic pain in people with anxiety and depression.

“I would love to see studies that do not exclude patients with co-morbid mental health conditions, as that would mimic the type of patients we see in the community, in real life,” Loftus said. “Including these patients can give us more insight into whether depression and anxiety is improved along with pain when treated with antidepressant medication. It can also offer a window into the interconnection between pain and mental health, and how they affect each other.”

Loftus, who has spent part of her career researching experimental treatments for depression, believes that research like this could lead to practitioners shifting away from SSRI’s (selective serotonin reuptake inhibitors) and towards SNRIs (serotonin and norepinephrine reuptake inhibitors), the class of drugs that duloxetine and milnacipran are a part of, as a first-line treatment. She says that this type of research methodology makes sense when we consider the connection between mind and body.

“It can’t be denied that our physical well-being, or lack thereof, will have a significant impact on our mental health. Hence, the idea of using antidepressant medications to treat either depression and anxiety secondary to chronic pain, or pain itself, is now standard of care,” Loftus said.