Which antidepressant classes are effective for which pain syndromes?
This umbrella review, summarizing the results of the most comprehensive systematic reviews of the use of antidepressants to treat various pain syndromes, found the only good evidence supported the use of SNRIs (eg, duloxetine, venlafaxine) to treat some types of pain, including back pain, postoperative pain, neuropathic pain, and fibromyalgia. Based on either moderate or low-quality evidence, other antidepressants in other classes were not effective for these types of pain or any others.
Self-funded or unfunded
These investigators searched 4 databases, including Cochrane CENTRAL, and identified 26 systematic reviews that collectively analyzed 156 trials that enrolled more than 25,000 participants, including children. They had no language limitations. They eliminated duplicate reviews (ie, those that covered the same question). Two investigators independently selected articles for inclusion and abstracted the data. The included reviews evaluated a total of 8 antidepressant classes for 22 pain conditions. Based on moderate certainty evidence, serotonin-norepinephrine reuptake inhibitors (SNRIs) produce clinically relevant decreases for back pain, postoperative pain, neuropathic pain, and fibromyalgia. Based on moderate-to-low certainty evidence, no other antidepressant classes significantly improved the pain syndromes mentioned above, or chronic pain, knee osteoarthritis, functional dyspepsia, and others.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine