Little evidence antidepressants help with chronic pain

A major new review has found that people with chronic pain are being prescribed antidepressants with very little scientific proof the medication helps.

In studies involving nearly 30,000 patients, there was “moderate” evidence for only one drug, duloxetine, and only for short-term pain relief.  There was also “shocking” lack of long-term data, even though the medication is usually prescribed for many months.

Chronic pain which lasts for more than three months is extremely common, with a recent survey suggesting one out of every four people in the UK is living with it.  There can be no obvious cause, or it may be linked to other health conditions such as arthritis.

Experts say brain systems for pain and mood overlap considerably, which is why it has been suggested antidepressants may help, and hundreds of thousands of patients with chronic pain in the UK are thought to be taking them.

The Cochrane review examined 176 trials, but most looked at patients’ experience over only a couple of months.  Among the drugs studied, including Prozac and amitriptyline, only one named duloxetine showed any evidence for pain relief.

None of the trials gathered long-term safety and effectiveness data, which the researchers say is shocking and needs remedying to guide patients and doctors.

Professor Tamar Pincus said “It’s really shocking that we don’t have any evidence for long-term use of even duloxetine.

“This is a global public-health concern.  Chronic pain is a problem for millions who are prescribed antidepressants without sufficient scientific proof they help, nor an understanding of the long-term impact on health.

“But it does not mean that people should stop taking prescribed medication without consulting their GP.”

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Posted by Karen Motley, Clinical Negligence Department, Chadwick Lawrence LLP (jacquelinevance@chadlaw.co.uk), medical negligence lawyers and clinical negligence solicitors in Huddersfield, Leeds, Wakefield and Halifax, West Yorkshire.

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