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Meta-Analysis
. 2008 Jan 23;2008(1):CD001703.
doi: 10.1002/14651858.CD001703.pub3.

Antidepressants for non-specific low back pain

D M Urquhart  1 , J L Hoving, W W J J Assendelft, M Roland, M W van Tulder
Affiliations
Meta-Analysis

Antidepressants for non-specific low back pain

D M Urquhart et al. Cochrane Database Syst Rev. .

Update in

  • Antidepressants for low back pain and spine-related leg pain.
    Ferraro MC, Urquhart DM, Ferreira GE, Wewege MA, Abdel Shaheed C, Traeger AC, Hoving JL, Visser EJ, McAuley JH, Cashin AG. Ferraro MC, et al. Cochrane Database Syst Rev. 2025 Mar 10;3(3):CD001703. doi: 10.1002/14651858.CD001703.pub4. Cochrane Database Syst Rev. 2025. PMID: 40058767

Abstract

Background: Antidepressants are commonly used in the management of low-back pain. However, their use is controversial.

Objectives: The aim of this review was to determine whether antidepressants are more effective than placebo for the treatment of non-specific low-back pain.

Search strategy: Randomised controlled trials were identified from MEDLINE and EMBASE (to September 2007), PsycINFO to June 2006, the Cochrane Central Register of Controlled Trials 2006, issue 2, and previous systematic reviews.

Selection criteria: We included randomised controlled trials that compared antidepressant medication and placebo for patients with non-specific low-back pain, and used at least one clinically relevant outcome measure.

Data collection and analysis: Two blinded review authors independently extracted data and assessed the methodological quality of the trials. Meta-analyses were used to examine the effect of antidepressants on pain, depression and function, and the effect of antidepressant type on pain. To account for studies that could not be pooled, additional qualitative analyses were performed using the levels of evidence recommended by the Cochrane Back Review Group.

Main results: Ten trials that compared antidepressants with placebo were included in this review. The pooled analyses showed no difference in pain relief (six trials; standardized mean difference (SMD) -0.06 (95% confidence interval (CI) -0.28 to 0.16)) or depression (two trials; SMD 0.06 (95% CI -0.29 to 0.40)) between antidepressant and placebo treatments. The qualitative analyses found conflicting evidence on the effect of antidepressants on pain intensity in chronic low-back pain, and no clear evidence that antidepressants reduce depression in chronic low-back pain patients. Two pooled analyses showed no difference in pain relief between different types of antidepressants and placebo. Our findings were not altered by the sensitivity analyses which varied the level of methodological quality required for inclusion in the meta-analyses to allow data from additional trials to be examined. Two additional trials were identified in September 2007 and await assessment.

Authors' conclusions: There is no clear evidence that antidepressants are more effective than placebo in the management of patients with chronic low-back pain. These findings do not imply that severely depressed patients with back pain should not be treated with antidepressants; furthermore, there is evidence for their use in other forms of chronic pain.

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Conflict of interest statement

One author (Maurits van Tulder) is co‐ordinating editor of the Cochrane Back Review Group. Editors are required to conduct at least one Cochrane review. This requirement ensures that editors are aware of the processes and commitment needed to conduct reviews. This involvement does not seem to be a source of conflict of interest in the Cochrane Back Review Group. Any editor who is a review author is excluded from editorial decisions on the review in which they are contributors.

Figures

1
1
Summary of risks of bias
1.1
1.1. Analysis
Comparison 1 Antidepressants versus placebo in chronic non specific low back pain, Outcome 1 Pain.
1.2
1.2. Analysis
Comparison 1 Antidepressants versus placebo in chronic non specific low back pain, Outcome 2 Depression.
1.3
1.3. Analysis
Comparison 1 Antidepressants versus placebo in chronic non specific low back pain, Outcome 3 Specific functional status.
2.1
2.1. Analysis
Comparison 2 SSRIs vs. placebo, Outcome 1 Pain.
3.1
3.1. Analysis
Comparison 3 TCAs vs. placebo, Outcome 1 Pain.
4.1
4.1. Analysis
Comparison 4 Atkinson 1998, Outcome 1 Method 1.
4.2
4.2. Analysis
Comparison 4 Atkinson 1998, Outcome 2 Method 2.
4.3
4.3. Analysis
Comparison 4 Atkinson 1998, Outcome 3 Method 3.
4.4
4.4. Analysis
Comparison 4 Atkinson 1998, Outcome 4 Method 1 Depression.
4.5
4.5. Analysis
Comparison 4 Atkinson 1998, Outcome 5 Method 2 Depression.
4.6
4.6. Analysis
Comparison 4 Atkinson 1998, Outcome 6 Method 3 Depression.
5.1
5.1. Analysis
Comparison 5 Atkinson 2007, Outcome 1 Atkinson 2007abc.
5.2
5.2. Analysis
Comparison 5 Atkinson 2007, Outcome 2 Atkinson 2007ab.
5.3
5.3. Analysis
Comparison 5 Atkinson 2007, Outcome 3 Atkinson 2007a.
See this image and copyright information in PMC

References

References to studies included in this review

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