Antidepressants for non-specific low back pain

Urquhart DM, Hoving JL, Assendelft WWJJ, Roland M, van Tulder MW

Summary

Antidepressants for non-specific low-back painLow-back pain is a common condition affecting up to 80% of adults over their lifetime. In the vast majority of cases, low-back pain has no identifiable cause and is termed "non-specific."

Low-back pain is usually benign and self-limiting. It generally resolves in six weeks, with or without treatment.

However, up to 30% of individuals who report low-back pain go on to have recurrent or persistent symptoms. As a result, low-back pain is one of the most common reasons for medical visits and it results in huge economic losses across developed nations because of reduced productivity, work absence and early retirement.

Antidepressants are a common treatment for low-back pain. Physicians prescribe them to patients with back pain for three main reasons: to provide pain relief, help with sleep and reduce depression. Unfortunately, the prescription of antidepressants as a treatment for back pain remains controversial, because of conflicting scientific evidence.

This review evaluated whether antidepressants are beneficial in the management of non-specific low-back pain. We identified ten studies which compared antidepressants to a placebo (an inactive substance that has no treatment value). All patients in these studies had low-back pain as a primary complaint and some participants also had symptoms of depression.

We looked at the results of individual studies and also combined the results of several studies in larger analyses.

The review could find no convincing evidence that antidepressants relieve back pain or depression more effectively than placebo. Antidepressants did not result in any other apparent benefits in the treatment of back pain.

Antidepressants did cause side-effects, however adequate information about these was not provided in the trials.

Patients with significant depression should not avoid antidepressants based on this review, as they continue to play an important role in the treatment of clinical depression. There is also evidence that antidepressants can help patients with other specific types of pain.

The review cautions that existing studies do not provide adequate evidence regarding antidepressants for low-back pain. There is a need for larger and more sophisticated studies to confirm the conclusions of this review. In the meantime, antidepressants should be regarded as an unproven treatment for non-specific low-back pain.