Antidepressants for pain management in adults with chronic pain: a network meta-analysis

作者：Hollie Birkinshaw, Claire Friedrich, P. Cole, Christopher Eccleston, Marc Serfaty, Gavin Stewart, Simon White, Andrew Moore, David Phillippo, Tamar Pincus · 发表于：Health Technology Assessment · 年份：2024 · DOI：10.3310/mkrt2948 · 被引用次数：40 · 研究领域：Musculoskeletal pain and rehabilitation、Fibromyalgia and Chronic Fatigue Syndrome Research、Pain Mechanisms and Treatments

Background: Chronic pain is common and costly. Antidepressants are prescribed to reduce pain. However, there has not been a network meta-analysis examining all antidepressants across all chronic pain conditions, so effectiveness and safety for most antidepressants for pain conditions remain unknown. Objective: To assess the efficacy and safety of antidepressants for chronic pain (except headache) in adults. Our primary outcomes were as follows: substantial pain relief (50%), pain intensity, mood and adverse events. Our secondary outcomes were as follows: moderate pain relief (30%), physical function, sleep, quality of life, Patient Global Impression of Change, serious adverse events and withdrawal. Design: This was a systematic review with a network meta-analysis. We searched CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS, AMED and PsycINFO databases for randomised controlled trials of antidepressants for chronic pain conditions up until 4 January 2022. The review was registered in PROSPERO (CRD42020171855), and the protocol was published in the Cochrane Library (https://doi.org/10.1002/14651858.CD014682). Setting: We analysed trials from all settings. Participants: We included trials in which participants had chronic pain, defined as longer than 3 months, from any condition excluding headache. Interventions: We included all antidepressants. Main outcome measures: Our primary outcome was substantial pain relief, defined as a reduction ˃ 50%. We also measured pain intensity, mood an...