Tricyclic and Tetracyclic Antidepressants Appear To Reduce Symptoms Of Chronic Low Back Pain

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Tricyclic and Tetracyclic Antidepressants Appear To Reduce Symptoms Of

Chronic Low Back Pain

A DGReview of : " Systematic review of antidepressants in the treatment of

chronic low back pain "

Spine

12/11/2003

By Jill

Antidepressants that inhibit norepinephrine reuptake (tricyclics and

tetracyclics) may be mildly to moderately effective in reducing chronic low

back pain, according to a new study.

Tricyclic antidepressants have been demonstrated to decrease pain associated

with diabetic neuropathy, postherpetic neuralgia, as well as provide benefit

in cases of fibromyalgia, migraines, and idiopathic pain.

Additionally, antidepressants are sometimes prescribed for analgesic

purposes in patients with back pain. However, previous reviews have reached

conflicting conclusions regarding the efficacy of antidepressants for

treatment of back pain.

To assess efficacy of antidepressants for the treatment back pain and

determine whether outcomes vary between antidepressant classes, O.

Staiger, MD, and colleagues of the University of Washington, Seattle, United

States performed a systematic literature review of randomised,

placebo-controlled trials of oral antidepressive agents in patients with

back pain.

Studies were identified through internet search of MEDLINE, PsycINFO, and

the Cochrane Controlled Trials Registry. Independent reviewers extracted

data, and assessed studies using a 22-point methodologic quality assessment

scale based on the 19-point criteria list developed by the Cochrane

Collaboration Back Review Group.

The reviewers identified 22 trials of antidepressants for the treatment of

back pain, of which 7 studies of chronic low back pain met inclusion

criteria. No adequate studies on the use of antidepressants for acute back

pain were found.

Among studies using antidepressants that inhibit norepinephrine reuptake

(tricyclic or tetracyclic antidepressants), 4 of 5 found significant

improvement in at least 1 relevant outcome measure. Furthermore, evidence

suggests that the effect of these antidepressants in chronic low back pain

is independent of patient depression status.

Conversely, no analgesic benefit was observed in studies of antidepressants

that do not inhibit norepinephrine reuptake (paroxetine and trazodone).

The impact of tricyclic medications on functional status in patients with

low back pain was unclear. Among 4 studies of tricyclic antidepressants that

included a functional measure, 1 found significant improvement, 1 found

borderline significant improvements, and 2 found no significant improvement.

" More research could better-define the benefits and risks of antidepressants

in the treatment of patients with chronic low back pain and whether

antidepressants can improve the functional status of these patients, "

conclude the researchers.

Spine 2003 Nov 15;28:22:2540-5