Department of Algology, Qinghai Provincial People's Hospital, Xining, China.
Department of Gastroenterology, Qinghai Provincial People's Hospital, Xining, China.
J Clin Pharmacol. 2024 Feb;64(2):205-214. doi: 10.1002/jcph.2365. Epub 2023 Oct 30.
Various antidepressants have introduced in clinical practice for pain management, but it is important to understand how to properly use them. We therefore performed a systematic review and network meta-analysis to compare and rank the efficacy and safety of antidepressants for patients with chronic back pain. We identified eligible randomized controlled trials (RCTs) that investigated the efficacy and safety of antidepressants for chronic back pain from PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov, searching from inception to May 2023. Six categories of antidepressants for the treatment of chronic back pain were included, and the surface under the cumulative ranking probabilities was applied to rank the treatment strategies. Overall, we selected 19 RCTs recruiting 2903 patients for the meta-analysis. Tricyclic antidepressants presented the best relative effects for relief in pain score (surface under the cumulative ranking, 84.4%). The results of pairwise comparison analyses found the use of serotonin-noradrenaline reuptake inhibitors (SNRIs) significantly reduced pain score and low disability score compared with placebo, irrespective of treatment duration. Noradrenaline-dopamine reuptake inhibitors (relative risk [RR], 2.80; 95% confidence interval [CI], 1.30-6.03; P = .008) and SNRIs (RR, 1.17; 95% CI, 1.07-1.27; P < .001) significantly increased the risk of adverse events. SNRIs were associated with an increased risk of withdrawal due to adverse events (RR, 2.37; 95% CI, 1.64-3.43; P < .001). This study found that antidepressants are more efficacious than placebos for treating chronic back pain, and tricyclic antidepressants are the most likely medications that lead to pain relief.
各种抗抑郁药已在临床实践中用于疼痛管理，但了解如何正确使用它们非常重要。因此，我们进行了系统评价和网络荟萃分析，以比较和评估抗抑郁药治疗慢性背痛患者的疗效和安全性。我们从 PubMed、Embase、Cochrane 图书馆和 ClinicalTrials.gov 中确定了符合条件的随机对照试验（RCT），这些试验调查了抗抑郁药治疗慢性背痛的疗效和安全性，检索时间从成立到 2023 年 5 月。纳入了治疗慢性背痛的 6 类抗抑郁药，并应用累积排序概率曲线下面积（surface under the cumulative ranking，SUCRA）来对治疗策略进行排序。总体而言，我们对纳入的 19 项 RCT 进行了荟萃分析，共招募了 2903 名患者。三环类抗抑郁药在缓解疼痛评分方面表现出最佳的相对效果（累积排序概率曲线下面积，84.4%）。成对比较分析的结果发现，与安慰剂相比，使用 5-羟色胺-去甲肾上腺素再摄取抑制剂（serotonin-noradrenaline reuptake inhibitors，SNRIs）可显著降低疼痛评分和较低的残疾评分，且与治疗持续时间无关。去甲肾上腺素-多巴胺再摄取抑制剂（相对风险[RR]，2.80；95%置信区间[CI]，1.30-6.03；P=0.008）和 SNRIs（RR，1.17；95% CI，1.07-1.27；P<0.001）显著增加了不良反应的风险。SNRIs 与因不良反应而停药的风险增加相关（RR，2.37；95% CI，1.64-3.43；P<0.001）。本研究发现，与安慰剂相比，抗抑郁药治疗慢性背痛更有效，三环类抗抑郁药是最有可能缓解疼痛的药物。
