Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies
Humans; Evidence-Based Medicine; Randomized Controlled Trials as Topic; Chronic disease; Pain/drug therapy/etiology; Fibromyalgia/drug therapy; Antidepressive Agents/therapeutic use; Arthritis/complications/drug therapy; Low Back Pain/drug therapy; Rheumatic Diseases/complications/drug therapy
The aim of this study was to review the evidence supporting the use of anti-depressants in painful rheumatological conditions. A systematic review of papers published between 1966 and 2007, in five European languages, on anti-depressants in rheumatological conditions was performed. Papers were scored using Jadad method and analgesic ES was calculated. We selected 78 clinical studies and 12 meta-analyses, from 140 papers. The strongest evidence of an analgesic effect of anti-depressants has been obtained for fibromyalgia. A weak analgesic effect is observed for chronic low back pain, with an efficacy level close to that of analgesics. In RA and AS, there is no analgesic effect of anti-depressants, but these drugs may help to manage fatigue and sleep disorders. There is no clear evidence of an analgesic effect inOA, but studies have poor methodological quality. Analgesic effects of anti-depressants are independent of their anti-depressant effects. Tricyclic anti-depressants (TCAs), even at low doses, have analgesic effects equivalent to those of serotonin and noradrenalin reuptake inhibitors (SNRIs), but are less well tolerated. Selective serotonin reuptake inhibitors (SSRIs) have modest analgesic effects, but higher doses are required to achieve analgesia. Anti-depressant drugs, particularly TCAs and SNRIs, have analgesic effects in chronic rheumatic painful states in which analgesics and NSAIDs are not very efficient, such as fibromyalgia and chronic low back pain. In inflammatory rheumatic diseases, anti-depressants may be useful for managing fatigue and sleep disorders. Further studies are required to compare anti-depressants with other analgesics in the management of chronic painful rheumatological conditions.
2008
Perrot S; Javier RM; Marty M; Le Jeunne C; Laroche F; CEDR (Cercle d'Etude de la Douleur en Rhumatologie France) Pain Study Section French Rheumatological Society
Rheumatology
2008
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/rheumatology/ken110" target="_blank" rel="noreferrer">10.1093/rheumatology/ken110</a>
Recommendations for using opioids in chronic non-cancer pain
Humans; Analgesics; Drug Administration Schedule; Psychology; Chronic disease; Biomarkers of Pain; Pain/drug therapy; Quality of Life/psychology; Opioid/therapeutic use; Patient Education
1. The management of chronic pain should be directed by the underlying cause of the pain. Whatever the cause, the primary goal of patient care should be symptom control. 2. Opioid treatment should be considered for both continuous neuropathic and nociceptive pain if other reasonable therapies fail to provide adequate analgesia within a reasonable timeframe. 3. The aim of opioid treatment is to relieve pain and improve the patient's quality of life. Both of these should be assessed during a trial period. 4. The prescribing physician should be familiar with the patient's psychosocial status. 5. The use of sustained-release opioids administered at regular intervals is recommended. 6. Treatment should be monitored. 7. A contract setting out the patient's rights and responsibilities may help to emphasize the importance of patient involvement. 8. Opioid treatment should not be considered a lifelong treatment.
2003
Kalso E; Allan L; Dellemijn PL; Faura CC; Ilias WK; Jensen TS; Perrot S; Plaghki LH; Zenz M
European Journal Of Pain
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/S1090-3801(02)00143-X" target="_blank" rel="noreferrer">10.1016/S1090-3801(02)00143-X</a>