- Researchers from Neuroscience Australia (NeuRA) and the University of NSW (UNSW) have found antidepressants provide little benefit when used to treat low back pain and sciatica.
- Low back pain is a leading cause of disability and reduced quality of life globally, impacting more than 4 million Australians.
- More research is required into antidepressants as a treatment for low back pain and sciatica, particularly on long-term effects and ceasing treatment.
Australian researchers have found antidepressants provide little to no benefit—and may even be harmful—when used to treat low back pain and sciatica, despite their widespread prescription.
The research by Neuroscience Research Australia (NeuRA) and the University of NSW (UNSW), published today in the Cochrane Library, reviewed evidence from 26 randomised controlled trials and involving more than 2900 participants with low back pain or sciatica, that tested an antidepressant medicine.
Lead author and Doctoral candidate at Centre for Pain IMPACT, NeuRA, and the School of Health Sciences UNSW, Michael Ferraro, said researchers assessed whether antidepressants were effective in reducing pain intensity and alleviating disability and safe, that is not increasing the risk of unwanted side effects.
"Low back pain has been the leading cause of disability worldwide for the past 30 years," Mr Ferraro said.
"Many people with low back pain also have pain that radiates down their leg, often leading to greater pain and disability. Antidepressants are commonly prescribed for low back pain and sciatica, despite conflicting recommendations from international clinical guidelines.
"We found that one class of antidepressants might provide back pain relief, but the effects are small and come with an increased risk of unwanted side effects. The long-term benefits and harms of most antidepressants for low back pain and sciatica remain unknown."
Three types of antidepressants reviewed
Antidepressants used and considered in the research included serotonin and norepinephrine reuptake inhibitors, (such as duloxetine, or 'Cymbalta'), selective serotonin reuptake inhibitors (such as escitalopram, or 'Lexapro'), tricyclic antidepressants (such as amitriptyline, or 'Endep') assessed against a placebo medicine.
The results showed with moderate certainty that one class of antidepressant medicines reduce back pain intensity and improve function, although effects were trivial.
"We found that serotonin and norepinephrine reuptake inhibitor medicines probably reduce pain within three to four months, but on average, the effects are probably too small to be important and many patients wouldn't be able to feel any difference in their pain compared to talking a sugar pill," Mr Ferraro said.
"They also come with an increased risk of unwanted side effects".
The findings also demonstrated with moderate certainty that tricyclic antidepressants probably have little to no effect on low back pain. For sciatica specifically, the evidence was too preliminary to permit any conclusions.
More research recommended
"Unfortunately, the available research does not tell us much about the effects of antidepressants on sciatica, despite their common use," Mr Ferraro said.
"Large, high-quality clinical trials of serotonin and norepinephrine reuptake inhibitors and tricyclic antidepressants are urgently needed to inform treatment of sciatica.
"We need more research on antidepressants for back pain and sciatica, especially to understand their longer-term effects, including those that might arise once treatment has stopped."
Researchers hope their findings might inform future clinical guidelines and assist clinicians and patients in the treatment decision-making process.
"Some patients may still choose to trial these medications, but informed discussions about the likely magnitude of benefit and possible risks are crucial," Mr Ferraro said.
"It's also important to stress, these findings do not imply that severely depressed people with low back pain and sciatica should not be treated with antidepressants."
