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Study Finds Commonly Prescribed Antidepressants Ineffective for Back Pain and Osteoarthritis

Back pain and osteoarthritis are “leading causes of disability worldwide.”[1]  So it is surprising to learn that doctors today are prescribing antidepressants to alleviate the pain associated with these conditions, despite the findings that there are very negative side effects to these drugs including dependence and withdrawal, not to mention the fact that the patients are not actually depressed.

Antidepressants for Chronic Pain

Most clinical practice guidelines advocate the use of antidepressants for the treatment of back pain and osteoarthritis. “More than one quarter of Americans with chronic low back pain are prescribed an antidepressant within three months of a first diagnosis.”[2]  Even the Mayo Clinic endorses antidepressants for back pain.  According to their website, “Some types of antidepressants — particularly duloxetine (Cymbalta) and tricyclic antidepressants, such as amitriptyline — have been shown to relieve chronic back pain independent of their effect on depression.”[3]  However, a recent 2021 study by the University of Sydney questions using antidepressants for not only back pain, but also for osteoarthritis.

University of Sydney Study

This study, published in the British Medical Journal, concluded that the use of antidepressants for treating chronic back pain and osteoarthritis were at best not very effective, and, at worst, actually harmful. “It is concerning as some antidepressants significantly increase the risk of a person to experience adverse events. Many people are being treated with these medications that may not be helping their pain and may be doing them harm,”[4]  stated lead author Dr. Giovanni Ferreira, PhD.  The study “found that for back pain the antidepressants were either ineffective or provided a very small effect, which was unlikely to be perceived as worthwhile by most patients. For people with osteoarthritis, effects were still small, but could be potentially perceived as worthwhile by some patients.”[5]

Harmful Side Effects

In addition to the negligible degree of pain relief, the long-term use of antidepressants for alleviating chronic pain brings additional problems, such as nausea and/or weight gain, plus the dangerous possibility of addiction and the unpleasant effects of withdrawal which include, “dizziness, nausea, anxiety, agitation, tremor, sweating, confusion and sleep disturbance.”[6]

Laser Therapy for Pain Relief

Laser therapy is non-invasive and “…has been reported to induce anti-inflammatory effects”[7] that help alleviate all types of pain without the negative side effects associated with antidepressants. And lasers can also help relieve the root causes of back pain and osteoarthritis — which may lead to permanent relief.  Laser therapy is also known as “low level laser therapy” or “LLLT.”  [“LLLT” is a common acronym used to describe the utilization of lasers for clinical therapy. It is not unique to any specific class of laser.]

Lasers Effective for Back Pain & Osteoarthritis

Studies have proven laser therapy to be highly effective for treating both back pain and osteoarthritis. A 2019 meta-analysis concluded that, “LLLT is an effective method to relieve low back pain in patients who present with NSCLBP.”[8] (“Nonspecific chronic low back pain”)  For osteoarthritis, a 2019 meta-analysis investigating the effectiveness of LLLT in knee osteoarthritis (“KOA”) concluded that “LLLT reduces pain and disability in KOA….”[9]

The Bottom Line

Antidepressants are now proven to not be worth the risk for those in search of relief for chronic pain. If you are a medical doctor, chiropractor, physical therapist, or acupuncturist, consider adding laser therapy to your treatment menu to provide non-risky, non-addictive, and truly effective pain relief to your patients suffering from chronic pain issues.

[1] Ferreira G E, McLachlan A J, Lin C C, Zadro J R, Abdel-Shaheed C, O’Keeffe M et al. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis, BMJ 2021; 372 :m4825 doi:10.1136/bmj.m4825, p1.

[2] Ibid., p. 2.

[3] https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911. Accessed 18 March 2021.

[4] University of Sydney.  News Release 20-Jan-2021: Do antidepressants help chronic back pain and osteoarthritis? 20 21 Jan 20, p. 1.

[5] Ibid.

[6] Ibid., p. 2.

[7] Stausholm MB, Naterstad IF, Joensen J, Lopes-Martins RÁB, Sæbø H, Lund H, Fersum KV, Bjordal JM. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open. 2019 Oct 28;9(10):e031142. doi: 10.1136/bmjopen-2019-031142. PMID: 31662383; PMCID: PMC6830679, p. 2.

[8] Huang Z, Ma J, Chen J, Shen B, Pei F, Kraus VB. The effectiveness of low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther. 2015 Dec 15;17:360. doi: 10.1186/s13075-015-0882-0. PMID: 26667480; PMCID: PMC4704537, p.6.

[9] Stausholm MB, Naterstad IF, Joensen J, Lopes-Martins RÁB, Sæbø H, Lund H, Fersum KV, Bjordal JM. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open. 2019 Oct 28;9(10):e031142. doi: 10.1136/bmjopen-2019-031142. PMID: 31662383; PMCID: PMC6830679, p. 11.

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