Which antidepressants are best for treating chronic pain?
In the journals
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Antidepressants are sometimes prescribed for chronic pain conditions even in people who do not have depression. But are these medications equally effective? A study published online Feb. 1, 2023, by The BMJ suggests not.
Antidepressants are thought to help by acting on chemicals in the brain that assist with pain relief, such as serotonin. Here, researchers looked at 156 trials involving more than 25,000 people that compared antidepressant with placebo treatment for any pain condition. Although most antidepressants prescribed for pain treatment are tricyclic antidepressants (amitriptyline is the most commonly used for pain) the evidence was unclear on how well these drugs work or whether they help treat most pain conditions. In comparison, antidepressants known as serotonin-norepinephrine reuptake inhibitors (SNRIs) — particularly duloxetine (Cymbalta) — were found to be the most effective, and proved useful for the largest number of pain conditions, including back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and nerve pain.
If you have chronic pain, talk to your doctor about whether an antidepressant might be an appropriate choice, and which one may be best for you.
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About the Author
Matthew Solan, Executive Editor, Harvard Men's Health Watch
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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