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Impact of Antidepressants Examined in Back Pain, Osteoarthritis

THURSDAY, Jan. 21, 2021 -- Serotonin-noradrenaline reuptake inhibitors (SNRIs) have a small and not clinically important effect on back pain, but may have a clinically important effect for osteoarthritis, according to a review published online Jan. 20 in The BMJ.

Giovanni E. Ferreira, from the University of Sydney, and colleagues conducted a systematic review and meta-analysis of randomized controlled trials of any antidepressant drug among patients with low back or neck pain, sciatica, or hip or knee osteoarthritis. Data were included for 33 trials with 5,318 participants.

The researchers found that based on moderate- and low-certainty evidence, SNRIs reduced back pain (mean difference, −5.30) and osteoarthritis pain (−9.72), respectively, at three to 13 weeks. Based on very low-certainty evidence, SNRIs reduced sciatica at two weeks or less (−18.60), but not at three to 13 weeks. Tricyclic antidepressants did not reduce sciatica at two weeks or less, but did reduce sciatica at three to 13 weeks and three to 12 months (−15.95 and −27.0, respectively) based on low- to very low-certainty evidence. Based on moderate-certainty evidence, SNRIs reduced disability from back pain at three to 13 weeks (−3.55); disability due to osteoarthritis was reduced at two weeks or less and three to 13 weeks (−5.10 and −6.07, respectively) based on moderate- and low-certainty evidence, respectively.

"Large, definitive randomized trials that are free of industry ties are urgently needed to resolve uncertainties about the efficacy of antidepressants for sciatica and osteoarthritis highlighted by this review," the authors write.

GlaxoSmithKline, Pfizer, and Flexeze provided support for the study.

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