What is the role of antidepressants in the treatment of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Tricyclic antidepressants (TCAs) are commonly used in chronic pain treatment to alleviate insomnia, enhance endogenous pain suppression, reduce painful dysesthesia, and eliminate other painful disorders such as headaches. Research supports the use of TCAs to treat both nociceptive and neuropathic pain syndromes. [57, 77, 103, 104] The presumed mechanism of action is related to the TCAs’ capacity to block serotonergic uptake, which results in a potentiation of noradrenergic synaptic activity in the CNS's brainstem-dorsal horn nociceptive-modulating system.

Also, studies in animals suggest that TCAs may act as local anesthetics by blocking sodium channels where ectopic discharges are generated. [104, 105] Two systematic reviews found that antidepressants reduced pain intensity in cLBP, but no consistent improvement in functional outcomes was measured. [106, 59, 61] Any efficacy for pain relief was seen primarily in tricyclic and tetracyclic antidepressants, whereas selective serotonin reuptake inhibitors (SSRIs) did not show similar properties or efficacy. [106]

Little evidence supports the use of SSRIs to attenuate pain intensity, and studies have suggested that these agents are inconsistently effective for neuropathic pain at best. [77]

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