Efficacy of antidepressants in the treatment of chronic nonspecific low back pain: a systematic review and meta-analysis
Creators: name: Filho, Márcio José Leão Nunes
name: Barreto, Eduardo Silva Reis
name: Júnior, César Romero Antunes
name: Alencar, Vinicius Borges
name: Lins-Kusterer, Liliane Elze Falcão
name: de Araujo Azi, Liana Maria Torres
name: Kraychete, Durval Campos
Publisher: name: Taylor & Francis
Year: 2024
Subjects: Medicine
Pharmacology
Biotechnology
Science Policy
Mental Health

description: <b>Aim:</b> This study reassesses the efficacy and safety of antidepressants in treating nonspecific chronic low back pain (NCLBP). <b>Materials &amp; methods:</b> A systematic review was conducted following PRISMA guidelines, including randomized clinical trials (RCTs) from PubMed, Embase, Scopus, LILACS, SciELO and Cochrane CENTRAL, published through August 2024. Studies compared antidepressants with placebo or active comparators. The primary outcomes were pain relief and quality of life. Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42023307516. <b>Results:</b> Nine RCTs involving 1758 patients were analyzed. The antidepressants examined included duloxetine, escitalopram, bupropion, amitriptyline, imipramine and desipramine. Duloxetine 60 mg significantly reduced pain (MD = -0.57; 95% CI = -0.78 to -0.36) and improved quality of life compared with placebo, with side effects that were generally tolerable. Notably, higher doses of duloxetine (120 mg) were associated with an increase in adverse events. However, other antidepressants like amitriptyline and escitalopram demonstrated only modest or inconsistent effects. <b>Conclusion:</b> Duloxetine at 60 mg provides consistent pain relief and improves the quality of life in NCLBP, but higher doses increase adverse events. Escitalopram might offer modest benefits but should be considered a third-line treatment. Other antidepressants, such as amitriptyline, bupropion, imipramine and desipramine, have limited evidence supporting their efficacy and are associated with adverse effects. Chronic lower back pain is a condition that persists for a long time and can be difficult to manage. While the exact cause isn't always clear, it affects many people and can be difficult to manage. Doctors sometimes prescribe antidepressants, which are typically used for treating depression, but they may also help to reduce pain by influencing how the brain processes it. In this paper, we examined several studies to determine whether these antidepressants are effective in treating chronic lower back pain. We analyzed nine studies involving 1758 participants who were treated with different medications: bupropion, duloxetine, escitalopram, amitriptyline, imipramine and desipramine. Among these medications, duloxetine stood out as the most effective. It not only helped to relieve pain but also improved the participants' ability to carry out daily activities. Additionally, duloxetine had fewer side effects than some of the other medications, although it can still cause mild issues such as nausea. In conclusion, duloxetine appears to be a promising option for managing chronic lower back pain, as long as the appropriate dosage is used to balance pain relief and side effects. <b>Study inclusion and population:</b> This review included nine randomized clinical trials (RCTs), involving a total of 1758 patients, with 1109 participants receiving antidepressants specifically for nonspecific chronic low back pain (NCLBP). <b>Antidepressant agents evaluated:</b> The review examined the efficacy of several antidepressants, including bupropion, duloxetine, escitalopram, amitriptyline, imipramine and desipramine. Duloxetine was the most extensively studied antidepressant. <b>Duloxetine outcomes:</b> Four trials focused on duloxetine, showing that the 60 mg dose provided the optimal balance between efficacy and tolerability, leading to improvements in pain and quality of life. However, higher doses were linked to increased adverse events and higher discontinuation rates. <b>Amitriptyline and escitalopram:</b> Based on single studies for each drug, amitriptyline and escitalopram may offer modest pain relief. However, neither showed significant improvements in disability or quality of life compared with placebo. <b>Bupropion, imipramine and desipramine:</b> These drugs did not demonstrate significant efficacy over placebo in reducing pain or improving disability. The evidence indicates minimal benefit in managing NCLBP. <b>Adverse events and discontinuation rates:</b> Discontinuation rates due to adverse effects were higher in the antidepressant groups across most studies, particularly with the use of higher doses of duloxetine.