PARIS, France—Antidepressants can be useful in treating the pain associated with some rheumatic conditions including fibromyalgia and chronic low back pain (LBP), but they may not have such pain-killing effects in other related diseases, according to a review article published in Rheumatology.1

“Antidepressant drugs, particularly tricyclic antidepressants (TCAs) and serotonin and noradrenalin reuptake inhibitors (SNRIs), have analgesic effects in chronic rheumatic painful states in which analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are not very efficient, such as fibromyalgia and chronic low back pain.”—Serge Perrot, MD
“Antidepressant drugs, particularly tricyclic antidepressants (TCAs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), have analgesic effects in chronic rheumatic painful states in which analgesics and [NSAIDs] are not very efficient, such as fibromyalgia and chronic [LBP],” concluded Serge Perrot, MD, of the Hotel Dieu Hospital in Paris, France. “In inflammatory rheumatic diseases, antidepressants may be useful for managing fatigue and sleep disorders.”

Major review backs antidepressants for fibromyalgia, LBP

The study authors reviewed the literature published between 1966 and 2007 in five European languages that concerned the use of antidepressants in rheumatic conditions. They graded the papers using the Jadad method and calculated the analgesic effect size. Overall, there were 78 clinical studies and 12 meta-analyses selected from 140 papers.

The strongest evidence of an analgesic effect of antidepressants was for fibromyalgia. There was a weak analgesic effect seen in chronic LBP. In rheumatoid arthritis and ankylosing spondylitis, however, there was no analgesic effect of antidepressants, but these drugs may help to manage coexisting fatigue and sleep disorders. Moreover, there is no clear evidence of an analgesic effect in osteoarthritis, but studies have poor methodological quality. Analgesic effects of antidepressants are independent of their antidepressant effects, the study authors conclude.

The researchers also compared the different types of antidepressants. TCAs, even at low doses, have analgesic effects equivalent to those of SNRIs, but have more untoward side effects. Selective serotonin reuptake inhibitors have modest analgesic effects, but higher doses are required to achieve analgesia, the review study found.

The bottom line? “Further studies are required to compare antidepressants with other analgesics in the management of chronic painful rheumatological conditions,” the authors conclude. ?

Reference
1. Perrot S, Javier R-M, Marty M, et al. Is there any evidence to support the use of antidepressants in painful rheumatic conditions? Systematic review of pharmacological and clinical studies. Rheumatology. 2008;47:1117-1123.