Re older antidepressants – A metanalysis of studies concluded the benefits were “small”
Salerno, Stephen M., Robert Browning, and Jeffrey L. Jackson. “The effect of antidepressant treatment on chronic back pain: a meta-analysis.” Archives of Internal Medicine 162.1 (2002): 19-24.
“In conclusion, adjunct antidepressant therapy at doses therapeutic for depression is associated with a small but significant reduction in the severity of chronic back pain but not improvement in activities of daily living.”
How about newer – Cymbalta:
To put the nail in the coffin, a review of antidepressants for spinal pain has just been published:
Ferreira GE, McLachlan AJ, Lin CW, Zadro JR, Abdel-Shaheed C, O’Keeffe M, Maher CG. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis. bmj. 2021 Jan 20;372.
“Conclusion Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low.”
So what about drug combinations?
Combinations do not work much in spinal pains and this has been concluded in a recent meta-analysis:
J Pain. 2019 Jan;20(1):1-15..Combination Drug Therapy for the Management of Low Back Pain and Sciatica: Systematic Review and Meta-Analysis. Mathieson S et al
“Most combinations had no or small effect on pain and disability”
Comment – the effects of gabapentin and pregabalin are no better. If there is interest, I will go over what could be used but much of it is here:
Reaching “Critical Mass” to Achieving Pain Control – Procedure Pearls