For many Australians, the struggle with low back pain and sciatica is a daily reality that significantly impacts their quality of life. In the quest for relief, it’s not uncommon for individuals to turn to various treatments, including the use of antidepressants. However, recent findings from Neuroscience Research Australia (NeuRA) and the University of New South Wales (UNSW) suggest that this approach may not be as effective as once thought.
The research, which delves into the efficacy of antidepressants for treating low back pain and sciatica, reviewed evidence from 26 randomised controlled trials involving more than 2900 participants. The results, published in the Cochrane Library, have raised questions about the widespread prescription of these medications for pain management.
Michael Ferraro, a Doctoral candidate at the Centre for Pain IMPACT, NeuRA, and the School of Health Sciences at UNSW, spearheaded the research. He and his team assessed whether antidepressants were effective in reducing pain intensity, alleviating disability, and ensuring safety by not increasing the risk of unwanted side effects.
‘Low back pain has been the leading cause of disability worldwide for the past 30 years,’ Ferraro noted, highlighting the gravity of the issue. ‘Antidepressants are commonly prescribed for low back pain and sciatica, despite conflicting recommendations from international clinical guidelines.’
The study examined three types of antidepressants: serotonin and norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs). The findings indicated that while one class of antidepressants, SNRIs, might offer some relief, the benefits were minimal and came with an increased risk of side effects.
‘We found that SNRI medicines probably reduce pain within three to four months, but on average, the effects are probably too small to be important, and many patients wouldn’t be able to feel any difference in their pain compared to taking a sugar pill,’ Ferraro explained. ‘They also come with an increased risk of unwanted side effects.’
The research also showed that TCAs likely have little to no effect on low back pain, and the evidence regarding their impact on sciatica was too preliminary to draw any conclusions.
Given these findings, the researchers are calling for more in-depth studies to understand the long-term effects of antidepressants on back pain and sciatica, including potential issues that might arise once treatment has stopped. Such research is crucial to inform future clinical guidelines and assist both clinicians and patients in making informed treatment decisions.
While some patients may still opt to try these medications, it’s essential to have informed discussions about the potential benefits and risks. It’s also important to note that these findings do not suggest that individuals with severe depression and low back pain or sciatica should avoid antidepressants altogether.
Have you or someone you know tried antidepressants for back pain or sciatica? What treatment approaches have worked best for you? Share your thoughts and experiences in the comments below—we’d love to hear from you.
Also read: Avoiding back pain – what the doctors say
