Can antidepressants also relieve pain? -Harvard Health Blog

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Did you know that people often prescribe antidepressants No Frustrated?

This is real. Antidepressants are commonly used for chronic pain, especially pain associated with neurological diseases (called neuropathic pain), chronic back or neck pain, and certain types of arthritis.

In fact, some treatments for chronic low back pain and Osteoarthritis (The most common type of arthritis) includes antidepressants. The FDA approved an antidepressant, specifically duloxetine (Cymbalta) for these conditions.

just how is it The awareness of antidepressants to reduce pain is not enough. One possibility is that they affect brain chemicals related to pain. This mechanism is different from the way they fight depression.

Usually not the first choice for pain relief

Antidepressants are generally not recommended for people with chronic low back or neck pain or hip or knee osteoarthritis. Usually try other methods first, such as physical therapy, exercise, weight loss, non-steroidal anti-inflammatory drugs (NSAID) or cortisone injections. However, if these methods do not help, then antidepressants such as duloxetine or amitriptyline may be taken as the next step.

When analgesics are prescribed, the initial dose is usually low (usually lower than the initial dose for depression). If necessary, it will gradually increase. Ideally, people will notice a benefit within a few weeks of starting the medication and can continue to use the medication at the lowest effective dose. If the pain is not well controlled, side effects occur or interaction with another drug occurs, it may be recommended to switch to another antidepressant.

A new study shows that antidepressants are not suitable for common types of pain

Past studies on the effects of antidepressants on chronic pain, such as Duloxetine in the treatment of knee osteoarthritis, Amitriptyline or B Used for chronic low back pain, and Amitriptyline in the treatment of chronic neck pain, Showing moderate short-term benefits. But research is limited: most trials are small and last only a few months or less. It is worth noting that in these trials, common drug side effects were nausea, constipation and erectile dysfunction.

Now one 2021 study Combined with past research data, we can better understand the safety and effectiveness of antidepressants in these situations. The news is bad:

  • On average, treatment with antidepressants minimized pain and disability compared to placebo. The improvement in pain (approximately 4 points on a scale of 0 to 100) was considered too small to be noticed.
  • People who use certain antidepressants to treat chronic pain often stop taking the drug because the drug is ineffective, causing unacceptable side effects, or both.
  • People with chronic pain and depression do not get more improvement than people with only chronic pain.

Sciatica may be an exception: antidepressants can relieve pain for up to a year. However, the quality of the previous studies was poor, so the authors of the study have no confidence in these conclusions.

These findings cast doubt on the usefulness of antidepressants for these common causes of chronic pain. However, they do not rule out the possibility that some people will get more relief from these drugs than others.

Bottom line

Available evidence suggests that, on average, the benefits of antidepressants for osteoarthritis or chronic low back pain and neck pain are modest at best, and often temporary. Disappointingly, for many patients with pain, there is no reliable and effective treatment (lack of joint replacement for osteoarthritis).

Therefore, if you are taking an antidepressant for pain relief and are not sure whether it is effective, please consult your doctor to see if you should consider stopping it. However, don’t stop it yourself.Your doctor suggests that there may be other reasons for using this drug. Many antidepressants should be gradually reduced instead of stopping immediately to avoid Discontinuation symptoms.

If you are taking an antidepressant to relieve pain, it is worth reviewing whether it is really doing anything for you and whether the list of medications should be shortened. Not only can you simplify your medical plan, but you can also reduce the cost of medications and the risk of drug-related side effects.

Follow me on twitter @RobShmerling

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