- Michael Roberts
- Health Correspondent, BBC News
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A large study of the effect of antidepressants was given to people with chronic pain without sufficient scientific evidence of their effectiveness.
Studies of nearly 30,000 patients found “moderate” evidence for the effect of only one drug, duloxetine, in reducing pain in the short term.
Although the pills were prescribed for several months, there was a “shocking” lack of long-term data.
Doctors advise to continue taking the medication if it is effective.
Experts say that patients should not stop taking pills suddenly before consulting a doctor.
What do the official health insurance guidelines say?
- Antidepressants may be used for some chronic pain conditions, including nerve pain and severe body pain called fibromyalgia.
- Strong opiate-based pain relievers, which can be addictive, are not recommended, nor are simple pain relievers such as paracetamol and ibuprofen.
- Exercise and physical activity programs may help, and some people may want to try psychological treatments such as cognitive behavioral therapy (CBT).
Chronic pain lasting more than three months is more common. One in four people in Britain live with it, according to a BBC News survey.
There is no clear cause for these pains, and they may be related to other health conditions, such as arthritis.
Experts say the brain systems for mood and pain overlap, which is why doctors recommend taking antidepressants. It is believed to affect hundreds of thousands of chronic pain patients in Britain.
At the age of thirteen, Luke woke up in excruciating pain – a decade later, his condition was still unrecognized.
The study, called Cochrane, was conducted by scientists from several British universities, including Southampton and Newcastle, in 176 trials. But most scientists focused on trying antibiotics in patients within two months.
Drugs studied include Prozac and a cheaper antidepressant called amitriptyline.
But only one drug, duloxetine, can relieve pain.
The study found no data on the safety and effectiveness of antibiotics over the long term, which the researchers say is shocking and should be taken into account to guide patients and doctors alike.
Professor Tamar Pincus said: “It is quite shocking that we have no evidence of an effect of long-term use of duloxetine.
He added: “This is a global public health concern. Chronic pain is a problem for millions of people who take antidepressants, without enough scientific evidence that they help them, and a lack of understanding of their long-term impact on health.”
“But that doesn’t mean people should stop taking prescription drugs without consulting their doctor,” he said.
“This review adds substantial evidence that we are disappointed with the use of drugs to treat chronic pain,” said Dr. Cathy Stannard, a senior consultant at the National Institute for Health and Care Excellence.
But translating findings from hospital trials to real life is difficult.
“We must equally emphasize the many social and psychological influences on the experience of pain,” said Dr. Stannard.
He added: “Services that typically take place outside of health care, including support for people with reduced mobility, trauma and social isolation, can help people in pain – identifying what’s most important to people and guiding them in ways to help them. Adequate support for them domestically is promising.
According to NHS guidelines, when coming off an antidepressant, the medication should be tapered off slowly over weeks to prevent withdrawal symptoms.
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