Article Impact Level: HIGH Data Quality: STRONG Summary of British Journal of Clinical Pharmacology, bcp.16234. https://doi.org/10.1111/bcp.16234 Dr. Sujita W. Narayan et al.
Points
- A systematic review of 15 randomized controlled trials assessed the efficacy and safety of antidepressants for pain management in adults aged 65 and older, with 1,369 total participants.
- The most commonly studied antidepressants were duloxetine and amitriptyline, each evaluated in 6 of the studies; knee osteoarthritis was the most frequently examined condition.
- For knee osteoarthritis, antidepressants did not show a significant effect on pain reduction in the immediate term (0–2 weeks), but duloxetine had a modest, statistically significant effect in the intermediate term (≥6 weeks and <12 months) with a mean difference of –9.1 points.
- Nearly half of the studies reported higher withdrawal rates due to adverse events in the antidepressant groups compared to the comparator groups, indicating potential concerns about side effects.
- The study concluded that the benefits and harms of antidepressant use for chronic pain in older adults are unclear, mainly due to small sample sizes, industry ties, and risk of bias in the trials, highlighting the need for more extensive, high-quality research.
Summary
In a systematic review of randomized controlled trials, researchers assessed the efficacy and safety of antidepressants compared to alternative treatments for pain management in adults aged 65 years and older. The study included trials published up to February 1, 2024, retrieved from 13 databases. A total of 15 studies met the inclusion criteria, encompassing 1,369 participants. The most frequently studied antidepressants were duloxetine and amitriptyline, each evaluated in 6 out of the 15 studies. Knee osteoarthritis was the most commonly examined condition, featured in 6 studies.
For knee osteoarthritis, antidepressants did not demonstrate a statistically significant effect on pain reduction in the immediate term (0–2 weeks), with a mean difference of –5.6 points on a 0–100 pain scale (95% confidence interval [CI]: –11.5 to 0.3). However, in the intermediate term (≥6 weeks and <12 months), duloxetine showed a statistically significant, though modest, effect with a mean difference of –9.1 points (95% CI: –11.8 to –6.4). Despite these findings, the clinical significance remains uncertain due to the small effect size. Additionally, nearly half of the studies (7 out of 15) reported increased withdrawal rates due to adverse events in the antidepressant groups compared to comparator groups.
The conclusions drawn highlight that the benefits and harms of antidepressant medications are unclear for most chronic painful conditions in older adults. The evidence is predominantly based on trials with small sample sizes (fewer than 100 participants), many of which have disclosed industry ties and were assessed as having an unclear or high risk of bias according to the Cochrane Risk of Bias tool. These factors underscore the necessity for more extensive, high-quality, randomized controlled trials to evaluate better the role of antidepressants in pain management for the elderly population.
Link to the article: https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.16234
References Narayan, S. W., Naganathan, V., Vizza, L., Underwood, M., Ivers, R., McLachlan, A. J., Zhou, L., Singh, R., Tao, S., Xi, X., & Abdel Shaheed, C. (2024). Efficacy and safety of antidepressants for pain in older adults: A systematic review and meta‐analysis. British Journal of Clinical Pharmacology, bcp.16234. https://doi.org/10.1111/bcp.16234
