Yes, here is a summary of the document titled:
Title: Antidepressants for Pain Management in Adults with Chronic Pain: A Network Meta-Analysis Published by: NIHR Health Technology Assessment, October 2024 DOI: 10.3310/MKRT2948 Lead Author: Hollie Birkinshaw et al.
To assess the efficacy and safety of antidepressants (excluding for headaches) in managing chronic pain in adults, using a network meta-analysis (NMA).
- Included 176 randomized controlled trials (RCTs) with 28,664 participants
- Pain conditions: Fibromyalgia (59 studies), Neuropathic Pain (49), Musculoskeletal Pain (40)
- Average study duration: 10 weeks
- Primary outcomes: ≥50% pain relief, pain intensity, mood, adverse events
- Secondary outcomes: ≥30% pain relief, physical function, sleep, quality of life, global impression, serious adverse events, withdrawal
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Duloxetine:
- Most consistently effective across all pain types and outcomes.
- Moderate-to-high certainty evidence for pain relief, mood, and physical function.
- Standard doses are as effective as high doses.
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Milnacipran:
- Some effectiveness for pain relief and secondary outcomes.
- Lower certainty due to fewer studies and participants.
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Other antidepressants:
- Insufficient or low-quality evidence for pain relief or safety.
- Examples: amitriptyline, fluoxetine, sertraline, paroxetine, etc.
- Most trials excluded patients with depression or low mood, so findings may not generalize to these populations.
- Lack of data on long-term outcomes or adverse effects.
- Safety data for all antidepressants were of very low certainty.
- Only duloxetine has robust evidence supporting its use for chronic pain.
- Milnacipran is promising but requires further study.
- Data do not support routine use of other antidepressants for chronic pain.
- Antidepressants should not replace non-pharmacological interventions when those are effective.
- Conduct longer-term trials (over 6 months)
- Include participants with comorbid depression
- Report adverse events, drug tolerance, and withdrawal more thoroughly