Antidepressants, commonly prescribed to relieve low back pain, don’t relieve it at all, according to a recent analysis of several studies.
The medications are routinely prescribed by almost a quarter of doctors who treat low back pain. But an overview of 10 published studies by the Cochrane Collaboration, a nonprofit group that appraises medical research, revealed that most of the studies found no more pain relief or improvement in function for patients taking antidepressants than for those taking placebos.
In fact, the researchers found, the antidepressants even failed to relieve depression, which is common among sufferers of chronic low back pain.
Most of the studies were performed on a past-generation class of medicines called tricyclic antidepressants, although a few studies included some of the newer mood-enhancing drugs, such as Wellbutrin and Paxil.
The results were a surprise in light of a review that appeared last fall in the journal Annals of Internal Medicine showing antidepressants to be apparently beneficial in relieving back pain. The dissonance could have come from the two reviews’ different approaches to measuring pain relief - though Cochrane reviews are perhaps the most highly regarded in medicine.
The large extent of antidepressant use in back pain treatment was revealed in a 2000 survey in the journal Archives of Family Medicine. The recent review, however, should not be a cause for those relying on antidepressants for back pain relief to stop using the drugs before discussing the matter with their doctors. Abruptly quitting antidepressants could set off a series of ugly side effects.
“Existing studies do not provide adequate evidence for or against the use of antidepressants in low back pain, and further research is needed,” said Cochrane review leader Donna Urquhart, a research fellow at Monash University in Melbourne, Australia. “In the meantime, antidepressants should be regarded as an unproven treatment for nonspecific low back pain.”
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