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Antidepressants in the Treatment for Chronic Low Back Pain: Questioning the Validity of Meta‐Analyses
Author(s) -
Williamson Owen D.,
Sagman Doron,
Bruins Robert H.,
Boulay Luc J.,
Schacht Alexander
Publication year - 2014
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12119
Subject(s) - duloxetine , medicine , placebo , analgesic , randomized controlled trial , duloxetine hydrochloride , venlafaxine , meta analysis , chronic pain , physical therapy , anesthesia , psychiatry , antidepressant , alternative medicine , anxiety , pathology
Objectives To contrast the analgesic effect of duloxetine with antidepressants reported in other published randomized clinical trials ( RCT s) and review articles in patients with chronic low back pain ( CLBP ). Methods In this narrative review, the results of 13 RCT s and 5 systematic reviews examining the analgesic effect of various antidepressants in CLBP were contrasted with those of 3 placebo‐controlled duloxetine RCT s. Treatment effects based on the Brief Pain Inventory ( BPI ) average score in the duloxetine RCT s were assessed in all completers (by study and overall) and in last‐observation‐carried‐forward ( LOCF ) analyses (extracted from study reports). 30%‐ and 50%‐reduction response rates were compared between duloxetine and placebo. Results Eleven different antidepressants were examined in 13 individual RCT s. Sample sizes, treatment durations, and analysis methods varied across studies. Reviews each included 5 to 9 of the RCT s and came to different conclusions regarding the analgesic effect of antidepressants: 2 found no evidence while 3 reported some evidence. The completer analysis showed greater improvements in BPI average scores with duloxetine vs. placebo (significant in 2 studies). Overall, the least square mean (standard error) difference between treatments was − 0.7 (0.15) ( P < 0.0001). Overall response rates were significantly larger with duloxetine than with placebo. Conclusions Due to the diversity of previous studies and the pooling methods used, the conclusions regarding the analgesic effect of antidepressants in CLBP drawn from systematic reviews must be interpreted with caution. Appropriately designed and powered studies similar to recently published duloxetine studies are recommended to demonstrate the analgesic effect of antidepressants.