Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors as adjuncts for postoperative pain management: systematic review and meta-analysis of randomised controlled trials

Wang, Li; Tobe, Joshua; Au, Emily; Tran, Cody; Jomy, Jane; Oparin, Yvgeniy; Couban, Rachel; Paul, James

doi:10.1016/j.bja.2021.08.032

Cited by 12 publications

(24 citation statements)

References 52 publications

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“…The 26 reviews provided efficacy estimates for eight classes of antidepressants. Efficacy estimates for tricyclic antidepressants (TCAs) were provided in 12 reviews, 17 32 36 49 51 54 55 56 57 58 60 64 followed by selective serotonin reuptake inhibitors (SSRIs) in 11 reviews, 16 31 32 36 47 50 56 59 61 62 63 serotonin-norepinephrine reuptake inhibitors (SNRIs) in eight reviews, 16 31 32 35 45 50 52 54 tetracyclic/atypical antidepressants in four reviews, 32 36 46 51 serotonin antagonist and reuptake inhibitors (SARIs) in two reviews, 32 53 and noradrenaline-dopamine reuptake inhibitors (NDRIs) 32 and monoamine oxidase inhibitors (MAOIs) 48 in one trial each.…”

Section: Resultsmentioning

confidence: 99%

“…Nine reviews provided evidence that some antidepressants were efficacious compared with placebo for nine conditions in 11 distinct comparisons. 16 17 31 32 35 45 51 52 56 Most reviews providing evidence that antidepressants were efficacious for pain were of SNRIs—six reviews covering seven conditions. 16 31 32 35 45 52 …”

Section: Resultsmentioning

confidence: 99%

“… 16 17 31 32 35 45 51 52 56 Most reviews providing evidence that antidepressants were efficacious for pain were of SNRIs—six reviews covering seven conditions. 16 31 32 35 45 52 …”

Section: Resultsmentioning

confidence: 99%

“… 15 Other types of pain, such as postsurgical, neuropathic, and cancer related are not classified under chronic primary pain, but the efficacy of antidepressants for these conditions has been investigated. 16 17 18 19 To provide patients and clinicians with an updated and comprehensive resource on the efficacy, safety, and tolerability of antidepressants to treat pain, we conducted an overview of relevant systematic reviews. Given the heterogeneity in the types of pain conditions for which the efficacy of antidepressants has been documented by existing systematic reviews, we chose to conduct an overview of systematic reviews to appraise efficacy estimates for each condition individually.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Ferreira

Shaheed

Underwood

et al. 2023

BMJ

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Objective To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition. Design Overview of systematic reviews. Data sources PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to 20 June 2022. Eligibility criteria for selecting studies Systematic reviews comparing any antidepressant with placebo for any pain condition in adults. Data extraction and synthesis Two reviewers independently extracted data. The main outcome measure was pain; for headache disorders it was frequency of headaches. Continuous pain outcomes were converted into a scale of 0 (no pain) to 100 (worst pain) and were presented as mean differences (95% confidence intervals). Dichotomous outcomes were presented as risk ratios (95% confidence intervals). Data were extracted from the time point closest to the end of treatment. When end of treatment was too variable across trials in a review, data were extracted from the outcome or time point with the largest number of trials and participants. Secondary outcomes were safety and tolerability (withdrawals because of adverse events). Findings were classified from each comparison as efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the grading of recommendations assessment, development, and evaluation framework. Results 26 reviews (156 unique trials and >25 000 participants) were included. These reviews reported on the efficacy of eight antidepressant classes covering 22 pain conditions (42 distinct comparisons). No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. 11 comparisons (nine conditions) were found where antidepressants were efficacious, four with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain (mean difference −5.3, 95% confidence interval −7.3 to −3.3), postoperative pain (−7.3, −12.9 to −1.7), neuropathic pain (−6.8, −8.7 to −4.8), and fibromyalgia (risk ratio 1.4, 95% confidence interval 1.3 to 1.6). For the other 31 comparisons, antidepressants were either not efficacious (five comparisons) or the evidence was inconclusive (26 comparisons). Conclusions Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions. Systematic review registration PROSPERO CRD42022311073.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“… 16 17 31 32 35 45 51 52 56 Most reviews providing evidence that antidepressants were efficacious for pain were of SNRIs—six reviews covering seven conditions. 16 31 32 35 45 52 …”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Ferreira

Shaheed

Underwood

et al. 2023

BMJ

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“…Of note, multiple studies found no significant effect of SSRIs in painful conditions such as fibromyalgia, migraine, and noncardiac chest pain, while their efficacy in neuropathic pain treatment has been scarcely studied [107][108][109][110]. SSRIs increase serotonergic activity by decreasing the presynaptic serotonin reuptake and are mainly metabolized by CYP2D6 and CYP2C19 [111,112].…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Pharmacogenetics and Pain Treatment with a Focus on Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Antidepressants: A Systematic Review

et al. 2022

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Background: This systematic review summarizes the impact of pharmacogenetics on the effect and safety of non-steroidal anti-inflammatory drugs (NSAIDs) and antidepressants when used for pain treatment. Methods: A systematic literature search was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines regarding the human in vivo efficacy and safety of NSAIDs and antidepressants in pain treatment that take pharmacogenetic parameters into consideration. Studies were collected from PubMed, Scopus, and Web of Science up to the cutoff date 18 October 2021. Results: Twenty-five articles out of the 6547 initially detected publications were identified. Relevant medication–gene interactions were noted for drug safety. Interactions important for pain management were detected for (1) ibuprofen/CYP2C9; (2) celecoxib/CYP2C9; (3) piroxicam/CYP2C8, CYP2C9; (4) diclofenac/CYP2C9, UGT2B7, CYP2C8, ABCC2; (5) meloxicam/CYP2C9; (6) aspirin/CYP2C9, SLCO1B1, and CHST2; (7) amitriptyline/CYP2D6 and CYP2C19; (8) imipramine/CYP2C19; (9) nortriptyline/CYP2C19, CYP2D6, ABCB1; and (10) escitalopram/HTR2C, CYP2C19, and CYP1A2. Conclusions: Overall, a lack of well powered human in vivo studies assessing the pharmacogenetics in pain patients treated with NSAIDs or antidepressants is noted. Studies indicate a higher risk for partly severe side effects for the CYP2C9 poor metabolizers and NSAIDs. Further in vivo studies are needed to consolidate the relevant polymorphisms in NSAID safety as well as in the efficacy of NSAIDs and antidepressants in pain management.

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Enantioselective LC-MS/MS determination of antidepressants, β-blockers and metabolites in agricultural soil, compost and digested sewage sludge

Arenas

Santos

Martín

et al. 2023

Analytica Chimica Acta

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Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors as adjuncts for postoperative pain management: systematic review and meta-analysis of randomised controlled trials

Cited by 12 publications

References 52 publications

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews

Pharmacogenetics and Pain Treatment with a Focus on Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Antidepressants: A Systematic Review

Enantioselective LC-MS/MS determination of antidepressants, β-blockers and metabolites in agricultural soil, compost and digested sewage sludge

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