Evidence-based data on pain relief with antidepressants

This structured review addresses the issue of whether antidepressants have an antinociceptive (analgesic) effect for chronic pain independent of their antidepressant effect. In order to answer this question, human acute pain studies, individual placebo-controlled studies for the treatment of specifi c chronic pain syndromes, and metaanalytic studies were reviewed and placed into table format. Analysis of this evidence led to the following conclusi ons: The evidence was consistent in indicating that overall antidepressants may have an antinociceptive effect in chronic pain, and that these drugs w ere effective for neuropathic pain. There was also some evidence that these drugs could be effective for psychogenic or somatoform disorder-associated pain. This evidence also strongly suggested that serotonergic-noradrenergi c antidepressants may have a more consistent antinociceptive effect than th e serotonergic antidepressants. Finally, this evidence indicated that antid epressants could be effective for pain associated with some specific pain s yndromes, such as chronic low back pain, osteoarthritis or rheumatoid arthr itis, fibrositis or fibromyalgia, and ulcer healing. Possible reasons for t he conflicting results of studies in this area are presented, and problems that could limit the validity of the conclusions of this review are discuss ed.