Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis

Antidepressants are widely used to treat pain, despite a lack of conclusive evidence to support this practice. To better understand the risks and benefits of antidepressants in the setting of back and osteoarthritis pain, researchers in Australia conducted a systematic review and meta-analysis. Evidence was derived from 33 randomized controlled trials including 5,318 participants with low back or neck pain, sciatica, or osteoarthritis of the knee or hip. The studies compared pain intensity and disability with antidepressants vs. placebo. The review authors found moderate-certainty evidence that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduce these outcomes for up to 3 months. Although the effect fell shy of clinical significance among patients with back pain, a clinically important benefit could not be ruled out in the case of osteoarthritis. SNRIs, along with tricyclic antidepressants (TCAs), additionally may offer clinical benefit to people with sciatica; but the certainty of that evidence was low to very low, and SNRIs also significantly elevated the risk of adverse events. Meanwhile, TCAs and other antidepressants demonstrated little effect on pain or disability. “Large, definitive randomized trials that are free of industry ties are urgently needed to resolve uncertainties about the efficacy of antidepressants for sciatica and osteoarthritis highlighted by this review,” the authors concluded.