Are Antidepressants Effective for Back Pain?

Chronic back pain often requires a multi-pronged approach to treatment. Antidepressants are one such prong, but a 2021 study questions their effectiveness.

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When you have chronic back pain, it should come as no surprise when your doctor prescribes pain medication. But what might be surprising, though, is when your doc prescribes antidepressants too. 

Woman needs antidepressants for back painAntidepressants have long been part of back pain treatment but a 2021 study questions their effectiveness.

Living day in and day out with pain can lead to a host of mental health issues. Many studies, such as this 2017 paper in The Spine Journalsuggest that chronic low back pain is often connected with a higher risk of anxiety and depression. 

“Chronic low back pain without the hope of a cure from an intervention seems a fertile trigger for a major depressive or dysthymic disorder,” says Brett Freedman, MD, Chair of the Division of Spine Surgery, Professor of Orthopedic Surgery, and Professor of Neurosurgery at Mayo Clinic. 

“Back pain most commonly is a non-specific, multi-factorial process that has a biological, psychological, and sociological effect,” Dr. Freedman adds. That’s why, he says, clinicians have considered antidepressants a means for managing back pain, “since it is an effective method for treating depression and anxiety, which are two psychological conditions seen commonly in patients with chronic musculoskeletal pain from any source, but particularly back pain.” 

Study Challenges Antidepressants for Back Pain

Despite the prevalence of antidepressants as a tool to use when treating back pain—especially chronic low back pain for which spine surgery is not a reliable option—one recent study is questioning the efficacy of these medications as it relates to chronic pain. 

In January 2021, The BMJ published research suggesting that antidepressants are ultimately ineffective for back pain and osteoarthritis. Studying 5,000 adults from multiple research studies, the researchers wrote that the effects on back pain were so small that antidepressants shouldn’t be considered “clinically important.”

Dr. Freedman is not persuaded by this study due to limitations in the research’s methodology. The research is a collection of 19 studies that each spanned the course of three months (except for one that went over three months). Dr. Freedman believes that for these studies to be truly comprehensive, they need to cover longer periods. 

“Back pain is a chronic condition,” he points out. “When we assess the impact of an interventional method, such as an injection or surgery, on back pain we typically assess this over a one- to two-plus-year time horizon. Further, when turning to the studies directly, even in the negative studies, there were positive findings related to the use of antidepressants, namely a reduction in use of other analgesic medications [painkillers].” 

Dr. Freedman states the evidence from this study alone is not strong enough “to change one’s current practice regarding the use of antidepressants in the multi-modal management of low back pain.” 

How Antidepressants Relieve Pain

Like other medical professionals, Dr. Freedman believes that depression and pain are interrelated. 

He says, “Certainly, my professional experience is that patients with a depressed mood feel more pain, and just as importantly, pain has a greater disabling effect in depressed people.”  

Dr. Freedman is not the only physician to make this observation. He notes that generally, providers have incidentally noticed reduced pain, improved function, and better self-efficacy in back pain patients with improved mental health as a result of antidepressants. 

“In the post-narcotic pain control era, providers have turned to multi-modal methods for managing back pain,” he says. “Antidepressants have become one of the agents included in this approach.”

Don’t Ignore Symptoms of Poor Mental Health

It can be understandably difficult to live with chronic pain, which is why it’s important to be on the lookout for depression symptoms. These can include: 

  • Loss of interest in previously enjoyed activities
  • Irritability
  • Social isolation
  • Sadness
  • Fatigue 

…and more. If you are experiencing these symptoms and have received a diagnosis of depression, it’s key to be open to treatments, which can include therapy, mindfulness, exercise, and antidepressants. 

Dr. Freedman says, “If you are depressed and have chronic low back pain, then you have two chronic illnesses that greatly affect your well-being. Therefore, both should be treated.” 

Updated on: 04/27/21
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Brett A. Freedman, MD
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