抗抑郁药治疗腰痛的疗效、可接受性和安全性：系统评价和荟萃分析。
Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis.
机构信息
Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.
School of Health Sciences, University of New South Wales, Sydney, Australia.
出版信息
Syst Rev. 2021 Feb 24;10(1):62. doi: 10.1186/s13643-021-01599-4.
BACKGROUND
Antidepressant medicines are used to manage symptoms of low back pain. The efficacy, acceptability, and safety of antidepressant medicines for low back pain (LBP) are not clear. We aimed to evaluate the efficacy, acceptability, and safety of antidepressant medicines for LBP.
METHODS
We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov , the EU Clinical Trials Register, and the WHO International Clinical Trial Registry Platform from inception to May 2020. We included published and trial registry reports of RCTs that allocated adult participants with LBP to receive an antidepressant medicine or a placebo medicine. Pairs of authors independently extracted data in duplicate. We extracted participant characteristics, study sample size, outcome values, and measures of variance for each outcome. We data using random-effects meta-analysis models and calculated estimates of effects and heterogeneity for each outcome. We formed judgments of confidence in the evidence in accordance with GRADE. We report our findings in accordance with the PRISMA statement. We prespecified all outcomes in a prospectively registered protocol. The primary outcomes were pain intensity and acceptability. We measured pain intensity at end-of-treatment on a 0-100 point scale and considered 10 points the minimal clinically important difference. We defined acceptability as the odds of stopping treatment for any reason.
RESULTS
We included 23 RCTs in this review. Data were available for pain in 17 trials and acceptability in 14 trials. Treatment with antidepressants decreased pain intensity by 4.33 points (95% CI - 6.15 to - 2.50) on a 0-100 scale, compared to placebo. Treatment with antidepressants increased the odds of stopping treatment for any reason (OR 1.27 [95% CI 1.03 to 1.56]), compared to placebo.
CONCLUSIONS
Treatment of LBP with antidepressants is associated with small reductions in pain intensity and increased odds of stopping treatment for any reason, compared to placebo. The effect on pain is not clinically important. The effect on acceptability warrants consideration. These findings provide Level I evidence to guide clinicians in their use of antidepressants to treat LBP.
TRIAL REGISTRATION
We prospectively registered the protocol for this systematic review on PROSPERO ( CRD42020149275 ).
背景
抗抑郁药被用于缓解腰痛的症状。抗抑郁药治疗腰痛（LBP）的疗效、可接受性和安全性尚不清楚。我们旨在评估抗抑郁药治疗 LBP 的疗效、可接受性和安全性。
方法
我们从成立到 2020 年 5 月，在 CENTRAL、MEDLINE、Embase、CINAHL、ClinicalTrials.gov、EU 临床试验注册处和世卫组织国际临床试验注册平台上搜索了已发表和试验注册报告的 RCT，这些 RCT 将成年 LBP 参与者分配接受抗抑郁药或安慰剂治疗。作者二人小组独立地重复提取数据。我们提取了参与者特征、研究样本量、每个结局的结局值和方差测量值。我们使用随机效应荟萃分析模型对每个结局进行了效应和异质性的估计。我们根据 GRADE 形成了对证据的置信判断。我们根据 PRISMA 声明报告我们的发现。我们在预先注册的方案中预先规定了所有结局。主要结局是疼痛强度和可接受性。我们在治疗结束时使用 0-100 点量表测量疼痛强度，并认为 10 点是最小的临床重要差异。我们将可接受性定义为因任何原因停止治疗的几率。
结果
我们在本次综述中纳入了 23 项 RCT。17 项试验提供了疼痛数据，14 项试验提供了可接受性数据。与安慰剂相比，抗抑郁药治疗可使疼痛强度降低 4.33 点（95%CI -6.15 至 -2.50）。与安慰剂相比，抗抑郁药治疗增加了因任何原因停止治疗的几率（OR 1.27 [95%CI 1.03 至 1.56]）。
结论
与安慰剂相比，抗抑郁药治疗 LBP 可使疼痛强度略有降低，因任何原因停止治疗的几率增加。对疼痛的影响没有临床意义。对可接受性的影响值得考虑。这些发现为指导临床医生使用抗抑郁药治疗 LBP 提供了 I 级证据。
试验注册
我们在 PROSPERO（CRD42020149275）上预先注册了该系统评价的方案。
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