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Despite inconclusive evidence of efficacy, antidepressants are prescribed widely for back pain and osteoarthritis, and their use is endorsed by numerous clinical practice guidelines. To clarify the efficacy and safety of antidepressants for these indications, researchers performed a meta-analysis of 33 randomized trials (5300 total patients) in which any antidepressant was compared with placebo in patients with hip or knee osteoarthritis, neck pain, or low back pain (with or without sciatica).
Most of the trials were industry-sponsored, few reported follow-up longer than 6 months, and most had significant methodological limitations. The meta-analysis provided moderate-certainty evidence that serotonin-norepinephrine reuptake inhibitors (SNRI…