Antidepressant Drugs for Back Pain?
"Do Antidepressant Medications Relieve Chronic Low Back Pain?", asks a recent research article in the Journal of Family Practice.1 The study begins by looking at the prevalence of back pain problems in the United States:
"Back pain is the second leading symptom prompting visits to physicians in the United States. For women 35 to 64 years of age and men 25 to 64 years of age, back discomfort is the leading symptomatic reason for visiting office-based physicians. Data from the National Ambulatory Medical Care Surveys (NAMCS) of 1977 and 1978 revealed that 61 percent of patients with back symptoms were treated by primary care physicians, and back symptoms ranked second among presenting complaints in the caseloads of internists and general family practitioners."The study next examined the percentage of patients that are treated with medication:
"Patients with back pain are frequently treated with a variety of medications. Drugs were prescribed in 61.5 percent of physician office visits for back symptoms from 1977 to 1978. Although data from that survey have not been published concerning the prevalence of prescription of antidepressant medications for patients with low back pain in primary care, it is known that tricyclic antidepressants were prescribed by primary care physicians in 2 percent of all office visits made by patients with low back pain in 1985. _Even though_ _antidepressant medications have not been approved by the_ _U.S. Food and Drug Administration for the treatment of_ _pain,_ physicians prescribe antidepressant medications to patients with low back pain for a number of reasons." (emphasis added)The study concluded: "The literature has not demonstrated that antidepressants are superior to placebos in improving low back pain or related problems." The following recommendation was made citing that the side effects of antidepressants were "from bothersome to dangerous":
"Meanwhile, given the lack of scientific support for the pain-relieving properties of antidepressants, physicians may want to exercise caution in prescribing these medications in hopes of pain relief for patients with low back pain who are not clinically depressed."Editor's note: Requests for reprints should be addressed to Judith Turner PhD, Department of Psychiatry and Behavioral Sciences RP-10, University of Washington School of Medicine, Seattle, WA 98195.
Reference
1. Turner J, Denny M. "Do antidepressant medications relieve chronic low back pain?" J Fam Pract 1993;37:545-553.
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