Serotonin-noradrenaline reuptake inhibitors (SNRIs) have a small and not clinically important effect on back pain, but they may have a clinically important effect for osteoarthritis, according to a paper published in BMJ. Investigators conducted a systematic review and meta-analysis of randomized controlled trials of any antidepressant drug among patients with low back or neck pain, sciatica, or hip or knee osteoarthritis. Data were included for 33 trials with 5,318 participants. Based on moderate- and low-certainty evidence, SNRIs reduced back pain (mean difference, −5.30) and osteoarthritis pain (−9.72), respectively, at 3-13 weeks. Based on very low-certainty evidence, SNRIs reduced sciatica at 2 weeks or less (−18.60), but not at 3-13 weeks. Tricyclic antidepressants did not reduce sciatica at 2 weeks or less, but did reduce sciatica at 3-13 weeks and 3-12 months (−15.95 and −27.0, respectively) based on low- to very low-certainty evidence. Based on moderate-certainty evidence, SNRIs reduced disability from back pain at 3-13 weeks (−3.55); disability due to osteoarthritis was reduced at 2 weeks or less and 3-13 weeks (−5.10 and −6.07, respectively) based on moderate- and low-certainty evidence, respectively.
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