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.