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Caruso R, Ostuzzi G, Turrini G, et al. Beyond pain: can antidepressants improve depressive symptoms and quality of life in patients with neuropathic pain? A systematic review and meta-analysis. Pain. 2019 May 22. doi: 10.1097/j.pain.0000000000001622. (Systematic review)
Abstract

Neuropathic pain can be a predictor of severe emotional distress, up to full-blown depressive states. In these patients, it is important to move beyond the sole treatment of pain, to recognize depressive symptoms, and to ultimately improve the quality of life. We systematically searched for published and unpublished clinical trials assessing the efficacy and tolerability of antidepressants vs placebo on depression, anxiety and quality of life in patients with neuropathic pain, and pooled data in a meta-analysis. A total of 37 studies fulfilled eligibility criteria and 32 provided data for meta-analysis. Antidepressants were more effective than placebo in improving depressive symptoms (standardized mean difference -0.11; 95% confidence interval -0.20 to -0.02), although the magnitude of effect was small, with a number needed to treat of 24. No significant difference emerged between antidepressants and placebo in reducing anxiety. Quality of life seemed improved in patients on antidepressants, as did pain. Acceptability and tolerability were higher in patients on placebo. To the best of our knowledge, this is the first meta-analysis specifically focusing on the effect of antidepressants on psychiatric symptoms and quality of life in patients with neuropathic pain. Our findings suggest that despite their potential benefit in patients with neuropathic pain, antidepressants should be prescribed with particular care because they might be less tolerable in such a fragile population. However, our findings warrant further research to explore how a correct use of antidepressants can help patients to cope with the consequences of neuropathic pain on their psychosocial health and quality of life.

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Physician 6 / 7
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Comments from MORE raters

Physician rater

There is no clinical reason not to use antidepressant medication for the treatment of comorbid depression/anxiety and neuropathic pain.

Physician rater

Chronic pain is a widespread and complex issue in many types of clinical practice, so it is likely useful for physicians to have confirmation that certain antidepressants may be helpful in treating chronic pain.

Physician rater

There is a mix of studies in this meta-analysis using various antidepressants - most used SNRIs, some - TCAs and also other antidepressants.

Physician rater

The article provides information on a very relevant area of medical practice for a general physician.

Physician rater

This is a very important review. Depression are very common in patients with chronic neuropathic pain. This study showed that there is benefit for improving depressive symptoms in patients treated with anti depressant. The use of systematic ways in finding and appraising the evidence are the strength of this review. Sub group analysis should be performed for SNRI (duloxetine). Future studies on antidepressants for neuropathic pain should consider not only the pain severity, but also the depression, anxiety, and, ultimately, quality of life.
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