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The Effect of Antidepressant Treatment on Chronic Back Pain
A Meta-analysis
Stephen M. Salerno, MD, MPH;
Robert Browning, MD;
Jeffrey L. Jackson, MD, MPH
Arch Intern Med. 2002;162:19-24.
Background Back pain is one of the most common problems in primary care. Antidepressant
medication is often prescribed, especially for chronic back discomfort, to
alleviate pain and restore the patient's ability to conduct activities of
daily living.
Objective To assess the efficacy of antidepressants in treating back pain in adults.
Methods We searched the MEDLINE (1966-2000), PsycLit, Cinhal, EMBASE, AIDSLINE,
HealthSTAR, CANCERLIT, the Cochrane Library (clinical trials registry and
the Database of Systematic Reviews), Micromedex, and Federal Research in Progress
databases and references of reviewed articles. Included articles were written
in English and dealt with randomized placebo-controlled trials of antidepressant
medication use among adults with chronic back pain. Two reviewers abstracted
data independently. Two continuous outcomes, change in back pain severity
and ability to perform activities of daily living, were measured. Study quality
was assessed with the methods used by Jadad and colleagues, and data were
synthesized using a random-effects model.
Results Nine randomized controlled trials with 10 treatment arms and 504 patients
were included. Seven treatment arms included patients with major depression.
Patients had chronic back pain, averaging 10.4 years. Patients treated with
antidepressants were more likely to improve in pain severity than those taking
placebo (standardized mean difference, 0.41; 95% confidence interval, 0.22-0.61)
but not in activities of daily living (standardized mean difference, 0.24;
95% confidence interval, -0.21-0.69). Patients treated with antidepressants
experienced more adverse effects (22% vs 14%, P =
.01) than those receiving placebo.
Conclusion Antidepressants are more effective than placebo in reducing pain severity
but not functional status in chronic back pain.
From the Departments of Medicine, Uniformed Services University of
the Health Sciences (Drs Salerno and Jackson), Walter Reed Army Medical Center
(Drs Salerno and Jackson), and National Naval Medical Center (Dr Browning),
Bethesda, Md. Dr Salerno is now with the Tripler Army Medical Center, Department
of Medicine, Tripler Army Medical Center, Hawaii.
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