Antidepressants for chronic pain: do they really work?

You might not have heard of it, but antidepressants are now being prescribed for managing chronic pain, such as back pain and knee osteoarthritis. That’s because some pieces of evidence show that these drugs may be effective for pain management, even when one isn’t experiencing any mood disorder.

The trend has gone so widespread that even when the National Institute for Health and Care Excellence (NICE) published a guideline for chronic primary pain management in 2021, they advised against using pain medicines, but antidepressants were exempted. In essence, they meant that using antidepressants for pain management was OK.

So, if NICE didn’t see any problems with using antidepressants for pain, does that mean you should go ahead? Are antidepressants really effective for managing chronic pain?

Antidepressants for pain: an inconclusive research

Although some studies suggest that some classes of antidepressants are effective for managing chronic pain, other types of antidepressants were either not effective or their effectiveness was unknown. Also, the risks are far too great, because different antidepressants come with different side effects.

And for someone who is battling pain but not a mood disorder, the potential side effects may far outweigh the benefits.

In summary, the results suggest that clinicians need to be aware of all the evidence and side effects before prescribing any antidepressant for pain.

So it wouldn’t be best to just pick the first antidepressant you could lay your hands on because you have arthritis.

It’s also worth noting that antidepressants are not approved by the FDA for use in chronic pain.

There is a role for antidepressants in helping people living with chronic pain, however, this is more limited than previously thought...We need to work harder to help people manage their pain and live better, without relying on the prescription pad, says Professor Martin Underwood, co-author of the research paper.

Which antidepressants are effective for pain?

In the research, serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants were found to be effective in the largest number of pain conditions. But surprisingly, tricyclic antidepressants whose effects on pain management are not clearly understood, are most commonly prescribed.

The study couldn’t conclude whether tricyclic antidepressants even work for pain at all.

So, one should be careful. These medications come with side effects, some of which you may want to avoid by all means. Whether you’re experiencing mood disorder or not, using antidepressants for chronic pain may not be advised. It’s not FDA-approved, and not all antidepressants are known to be effective at all.

Even if an antidepressant does work for pain, the side effects may not be worth it, and you could do better with some other pain management techniques, such as exercise, physiotherapy, and lifestyle changes.

More on the research here.

Author

Satu H. Woodland, PMHCNS-BC, APRN Satu Woodland is owner and clinician of Hope Mental Health, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.  Ms. Woodland with her background in nursing, prefers a holistic and integrative approach to mental health care that addresses the mind and body together. While Ms. Woodland provides medication management services in all her patients, she believes in long-lasting solutions that include a number of psychotherapies, namely cognitive behavioral therapy, exposure and response prevention therapy, attention to lifestyle, evidenced based alternative psychiatric care and spirituality. If you’d like to gain control over your mental health issues, call Hope Mental Health at 208-918-0958, or use the online scheduling tool to set up an initial consultation.