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Experts say there are ways to ease chronic pain without taking medication. Justin Paget/Getty Images
  • Researchers say that for the most part antidepressant medications are not effective in treating chronic pain.
  • Experts say non-opioid agents can be an alternative.
  • They add that some pain relief can be obtained through exercise, acupuncture, and physical therapy.

Antidepressant medications have proven effective in addressing mental health symptoms.

However, using these drugs to ease physical discomfort is probably ineffective, according to a study published today in The BMJ.

Prescriptions for antidepressants have increased rapidly in recent decades and spiked during the COVID-19 pandemic. While most of these prescriptions were to address depression, researchers suspect that off-label prescriptions of antidepressants to treat chronic pain, including fibromyalgia, persistent headaches, and osteoarthritis, also have contributed to the trend.

A systematic review of published studies on using antidepressants for pain management, however, found little evidence that these off-label prescriptions were effective.

“No review provided high certainty evidence on the effectiveness of antidepressants for pain for any condition,” the study authors wrote.

The researchers examined 42 studies.

They said that only 11 studies, covering only nine of 22 chronic pain conditions, showed any evidence of effectiveness.

For example, evidence classified as “moderate certainty” suggested that serotonin-norepinephrine reuptake inhibitors (SNRIs) may help with back pain, postoperative pain, fibromyalgia, and neuropathic pain.

“Low certainty” evidence suggested that SNRIs helped with pain linked to breast cancer treatment, depression, knee osteoarthritis, and pain related to other underlying conditions.

There was also low certainty evidence that selective serotonin reuptake inhibitors (SSRIs) were effective for people with depression and pain related to other conditions.

There also wasn’t significant evidence that tricyclic antidepressants (TCAs) were effective for irritable bowel syndrome, neuropathic pain, and chronic tension-type headache.

In addition, researchers said they found no “high certainty” evidence that any class of antidepressants was effective pain medication.

“Some antidepressants were efficacious for some pain conditions; however, efficacy appears to depend on the condition and class of antidepressant,” according to the multinational research team led by Dr. Giovanni Ferreira of the University of Sydney in Australia. “The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain.”

The study suggests that “for most adults living with chronic pain, antidepressant treatment will be disappointing,” wrote Cathy Stannard, a pain consultant for the United Kingdom’s NHS Gloucestershire Integrated Care Board, and Colin Wilkinson of the Centre for Pain Research at the University of Bath, in an unaffiliated commentary published alongside the study.

“This is important given emerging concerns about increases in the prescribing of antidepressants and the challenges patients describe when trying to withdraw from treatment,” she added.

Dr. Alopi M. Patel, an assistant professor in the Department of Anesthesiology, Perioperative, & Pain Medicine at the Icahn School of Medicine at Mount Sinai in New York, told Healthline that prescribing antidepressants for chronic pain is “not very common.”

“However, low-dose anti-depressants such as tricyclic antidepressants may be prescribed to help with nerve-related pain,” said Patel. “They essentially work as neuromodulating medications that can help decrease pain sensation.”

“Various reputable treatment guidelines recommend antidepressants as effective medications for chronic pain,” added Dr. Lokesh Shahani, an associate professor of psychiatry at McGovern Medical School at UTHealth Houston.

“Our understanding of the neurobiology of antidepressants supports the use of antidepressants for chronic pain,” Shahahi told Healthline. “Pain medications, NSAIDS, and opioids are more effective. However, [they are] associated with side effects and risk of dependence.”

Whether they directly reduce pain or not, antidepressants still have a role to play in treating people who have chronic pain, experts said.

“At present, a number of other non-opiate agents are considered to be more viable and valuable than… anti-depressants, either as primary or adjunctive treatments for pain,” said Dr. James Giordano, a professor of neurology and biochemistry at Georgetown University Medical Center’s Pellegrino Center for Clinical Bioethics in Washington, DC.

“However, given that chronic pain can and very often does present as a constellation of signs and symptoms, including changes in mood, sleep, and appetite, the use of anti-depressants, for their psychotropic effects, may still be advocated and warranted,” Giordano told Healthline.

He added that antidepressants “can be used as adjunctive agents to treat comorbid pain and depression.”

Experts added that non-medication interventions, including exercise, acupuncture, and physical therapy, also can help people with chronic pain.

“Chronic pain can be managed utilizing a variety of approaches that range from low tech — certain forms of meditation, hypnosis, and self-hypnosis, massage, yoga — to more mid-level technical interventions (such as biofeedback, neurofeedback, and peripheral neurological stimulation), to very high-tech approaches that include transcranial forms of neuromodulation … as well as cutting edge technologies, such as deep brain stimulation,” said Giordano.