Antidepressants used for pain relief despite no proof they work
HUNDREDS of thousands of Britons suffering with chronic pain have been prescribed antidepressants as a treatment despite no evidence that they work, a review has found.
Antidepressants are commonly prescribed for people living with chronic pain often caused by fibromyalgia, nerve conditions or musculoskeletal damage.
The most common antidepressant used to treat chronic pain, amitriptyline, is cheap and given to millions of people a year. However, there is no evidence it works, the review said.
Scientists want the current prescription guidelines set out by Nice to be reassessed, but the body says there is “not sufficient” reason to alter current guidance.
Another antidepressant, duloxetine, was found to be effective at alleviating chronic pain. However, it is more expensive and prescribed less frequently than amitriptyline.
Patients taking amitriptyline have been told not to stop taking the drug, especially if it is working for them, but to talk to their GP about whether they would benefit more from another course of action.
Scientists led by the universities of Southampton and Newcastle analysed data from 176 different trials on nearly 30,000 people who had been taking antidepressants for pain relief as part of a Cochrane review.
Prescriptions for people with depression were excluded to solely focus on the role of the drugs in alleviating pain.
Analysis found a lack of evidence proving antidepressants were effective at relieving chronic pain. There was only enough data to make conclusions on three drugs; only one of those, duloxetine, showed signs of being effective.
Prof Tamar Pincus from the University of Southampton was part of the review, which she called the “gold standard” for evidence, and said GPS were running out of treatments for chronic pain. Opioids have recently been removed as an option, as have paracetamol and ibuprofen.
“What GPS are left with as this funnel gets narrower and narrower is antidepressants, and the prescription of antidepressants for people with chronic pain is on the rise,” Prof Pincus said.
In one year in the UK there were 15million prescriptions at a low dose for amitriptyline.
“Amitriptyline at a low doses is almost always for things like pain and sleep,” Prof Pincus said.
“So a very, very rough estimate suggests that we have got hundreds of thousands of people being prescribed amitriptyline in the UK for pain without evidence,” she said.
Gavin Stewart, a statistician from Newcastle University and review coauthor, said the team was calling on Nice and the US Food and Drug Administration to update their guidelines.
A Nice spokesman said: “Nice has conducted a careful and comprehensive review of the findings and we have concluded that the new evidence is not sufficient to warrant an update to the recommendations in our chronic pain guideline at this stage.”