A systematic review of clinical trials showed insufficient evidence to support the clinical use of antidepressants in the treatment of acute or chronic postoperative pain.
Researchers performed a systematic review of all currently published clinical trials on antidepressants and postoperative pain and included 15 studies on acute and three studies on chronic postoperative pain in the final outcome. Extracted data included pain at rest and with movement, adverse effects and other outcomes.
Researchers found the 15 studies of early postoperative pain evaluated amitriptyline, bicifadine, desipramine, duloxetine, fluoxetine, fluradoline, tryptophan and venlafaxine, while three studies of chronic postoperative pain prevention evaluated duloxetine, escitalopram and venlafaxine. Study results showed heterogeneity due to differences in drug, dosing regimen, outcomes or surgical procedure precluded any meta-analyses. In 8 of the 15 trials, superiority to placebo was reported for early pain reduction. Superiority to placebo was also reported in one of three trials for chronic pain reduction. According to study results, the majority of positive trials did not report sufficient data to estimate treatment effect sizes and many studies had inadequate size, safety evaluation/reporting, procedure specificity and movement-evoked pain assessment.
“There is a need for improved treatment options in the management of postoperative pain, and antidepressants could potentially be a valuable addition,” Ian Gilron, MD, professor and director of clinical pain research at Queen’s University in Ontario, Canada, stated in a press release. “Our review of the literature showed several positive trial results, but we also found important research limitations in the studies, indicating a need for higher quality, more definitive trials on antidepressant use for postsurgical pain.”
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Disclosure: Gilron received support from Pfizer, Aventis Pharma, Novopharm, PharmaScience, Apotex, Merck-Forsst, Johnson & Johnson, Ortho-McNeill and Janssen-Ortho and received grants from the Canadian Institutes of Health Research, Physicians’ Services Incorporated Foundation and Queen’s University. Kalso received consulting fees from Pfizer, Grunenthal, Janssen-Cilag, Orion-Pharmos and Pharmaleads. Raja received research support of consulting fees from Allergan, Alpharma, Schering-Plough, Medtronic, Pfizer and QRx Pharma.