Antidepressants Don't Show Major Effect on Musculoskeletal Pain

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Antidepressants are not associated with major improvements in back pain or knee osteoarthritis, according to a meta-analysis in The BMJ.

Researchers analyzed 33 trials that compared antidepressants with placebo in roughly 5300 patients with back pain, knee osteoarthritis, or both.

There was some evidence that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced pain and disability for up to 3 months. However, for back pain, the effects weren't likely to be clinically meaningful, while for osteoarthritis, the authors couldn't rule out a clinically important effect on pain. For patients with sciatica, tricyclic antidepressants and SNRIs may reduce pain, but the certainty of the evidence was low. SNRIs were associated with higher risk for adverse events, but not serious adverse events.

Editorialists conclude: "Overall ... drug treatments are largely ineffective for back pain and osteoarthritis and have the potential for serious harm. We need to work harder to help people with these disorders to live better with their pain without recourse to the prescription pad."