This site is intended for health professionals only


‘Antidepressants better for pain than painkillers’



Antidepressants have been recommended to treat chronic pain, such as long-term back pain, in guidance from the National Institute for Health and Care Excellence.

The draft clinical guidelines for assessing and managing chronic pain in over 16’s, published over the summer, warned that commonly used treatments such as painkillers ‘can do more harm than good.’

NICE stated that medication such as paracetamol, aspirin, ibuprofen, benzodiazepines, or opioids ‘made little difference to people’s quality of life’ and should not be offered to patients with chronic primary pain.

According to NICE, chronic pain may affect up to half of the population of the UK. It is defined by the World Health Organisation (WHO) as a pain that persists for longer than three months and is associated with significant emotional distress or functional disability and is not the symptom of an underlying condition. This type of pain can include chronic musculoskeletal pain, pelvic pain, and back pain.

The new guidance recommends that some antidepressants, including duloxetine, amitriptyline and the SSRIs 13 fluoxetine, paroxetine, citalopram, and sertraline, should be considered for people with chronic primary pain.

NICE noted that this is an ‘off label’ use of antidepressants, but the guidance is based on evidence from trials where patients suffering from chronic pain took antidepressants and ‘showed an improved quality of life, with reduced pain and psychological distress’ as opposed to those taking a placebo.

As well as re-assessing chronic pain medication, the NICE guidance highlighted the effectiveness of alternative therapies such as acupuncture and the importance of putting the patient at the centre of their care.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: ‘When many treatments are ineffective or not well tolerated, it is important to get an understanding of how pain is affecting a person’s life and those around them because knowing what is important to the person is the first step in developing an effective care plan.’

He added: ‘Importantly the draft guideline also acknowledges the need for further research across the range of possible treatment options, reflecting both the lack of evidence in this area and the need to provide further choice for people with the condition.’