Do Antidepressants Improve Chronic Pain in Pediatric Patients?
These studies compared amitriptyline vs placebo, amitriptyline vs gabapentin, and citalopram vs placebo.
Although some research demonstrates the beneficial use of antidepressants in reducing chronic non-cancer pain in adults, a review published in The Cochrane Database of Systematic Reviews failed to find conclusive evidence of the efficacy of this class of drugs in the pediatric population.1
Investigators searched several clinical trial databases to evaluate the analgesic effect and adverse events associated with antidepressants in the treatment of chronic non-cancer pain in pediatric patients. All studies included in this review were randomized controlled trials that investigated the effects of antidepressants given at any dose or via any route.
Only 4 studies with a total of 272 patients were included in the final analysis. Patients were age 6 to 18 and diagnosed with complex regional pain syndrome type 1, chronic neuropathic pain, functional abdominal pain, irritable bowel syndrome, or functional dyspepsia. These studies compared amitriptyline vs placebo, amitriptyline vs gabapentin, and citalopram vs placebo.
The investigators noted that no study reported subjective pain relief of ≥30% or ≥50%, indicating low-quality evidence. No serious adverse events (AEs) were reported; however, one AE did occur in the active treatment groups. All AEs across all 4 studies were considered mild (eg, nausea, dizziness, drowsiness).
This review included only 4 studies with a small number of patients, providing insufficient evidence for drawing a conclusive finding regarding the analgesic efficacy of antidepressants in these patients. In addition, a meta-analysis was not performed, thus limiting the investigators' ability to make a rational judgement on the efficacy or harm associated with antidepressants in chronic non-cancer pain.
Despite the limitations, researchers comment that their results “have the potential to inform policymaking decisions for funding future clinical trials into antidepressant treatment of child and adolescent pain, therefore any results (large or small) are important in order to capture a snapshot of the current evidence for antidepressants.”
Cooper TE, Heathcote LC, Clinch J, et al. Antidepressants for chronic non-cancer pain in children and adolescents. Cochrane Database Syst Rev. 2017;8:CD012535.