Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies

Abstract

The aim of this study was to review the evidence supporting the use of anti-depressants in painful rheumatological conditions. A systematic review of papers published between 1966 and 2007, in five European languages, on anti-depressants in rheumatological conditions was performed. Papers were scored using Jadad method and analgesic ES was calculated. We selected 78 clinical studies and 12 meta-analyses, from 140 papers. The strongest evidence of an analgesic effect of anti-depressants has been obtained for fibromyalgia. A weak analgesic effect is observed for chronic low back pain, with an efficacy level close to that of analgesics. In RA and AS, there is no analgesic effect of anti-depressants, but these drugs may help to manage fatigue and sleep disorders. There is no clear evidence of an analgesic effect inOA, but studies have poor methodological quality. Analgesic effects of anti-depressants are independent of their anti-depressant effects. Tricyclic anti-depressants (TCAs), even at low doses, have analgesic effects equivalent to those of serotonin and noradrenalin reuptake inhibitors (SNRIs), but are less well tolerated. Selective serotonin reuptake inhibitors (SSRIs) have modest analgesic effects, but higher doses are required to achieve analgesia. Anti-depressant drugs, particularly TCAs and SNRIs, have analgesic effects in chronic rheumatic painful states in which analgesics and NSAIDs are not very efficient, such as fibromyalgia and chronic low back pain. In inflammatory rheumatic diseases, anti-depressants may be useful for managing fatigue and sleep disorders. Further studies are required to compare anti-depressants with other analgesics in the management of chronic painful rheumatological conditions.

Consenso brasileiro do tratamento da fibromialgia

“…Fifteen papers were selected, in its majority metanalysis, and also guidelines. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] At Cochrane Library, the term "fibromyalgia" yielded one paper in the session of complete metanalysis. 23 In the part of protocols, two unfinished projects were identified.…”

Management of Chronic Pain in the Rheumatic Diseases with Insights for the Clinician

“…Antidepressant medications affect pain independently of their impact on mood, with pain relief occurring as early as 2 weeks following initiation of treatment [Chan et al 2009;Perrot et al 2008;Bannwarth, 2005;Lynch, 2001]. Although mostly studied in fibromyalgia, there is evidence for effect in other rheumatic conditions where analgesics and NSAIDs are not sufficiently effective [Perrot et al 2008]. The major mechanism of action is to affect descending pain inhibitory pathways in the brain stem and spinal cord mediated by norepinephrine and serotonin.…”

Pain Associated with Rheumatoid Arthritis

“…A systematic review [50] of papers published between 1966 and 2007 on antidepressants in rheumatologic conditions looked at 78 clinical studies and 12 meta-analyses from 140 papers. The strongest evidence of an analgesic effect of antidepressants has been obtained in fibromyalgia.…”