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Selective Serotonin Reuptake Inhibitors Are Effective for Mixed Chronic Pain

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Selective Serotonin Reuptake Inhibitors Are Effective for Mixed Chronic Pain Review: Selective serotonin reuptake inhibitors are effective for Evid Based Med: first published as 10.1136/ebm.1998.3.12 on 1 February 1998. Downloaded from mixed chronic pain Jung AC, Staiger T, Sullivan M. The myalgia; patient numbers; and clini- ever, in 2 other studies, patients efficacy of selective serotonin cal response. received paroxetine or citaioprarr reuptake inhibitors for the manage- improved pain reduction comparec ment of chronic pain, J Gen Intern Main results those who received placebo (P < Med. 1997Jun;12:384-9. 19 studies met die selection criteria. 10 and P = 0.02, respectively). 3 stud studies with 550 patients evaluated the 83 patients with fibromyalgia were t effectiveness of SSRIs in patients with 2 studies found no differences bet Objective chronic headache. In 3 separate studies, SSRIs (fluoxetine and citalopram To determine the effectiveness of se- improvement in chronic tension-type placebo for fibromyalgia, wher lective serotonin reuptake inhibitors headache was found with paroxetine study found improvement with fli (SSRIs) in the management of chronic (P < 0.05), fluoxetine (P = 0.029), and tine, especially when used with am pain. fluvoxamine (P < 0.05). However, in tyline. 3 studies of 119 patients 1 placebo-conn-oiled study, no improve- mixed chronic pain showed more Data sources ment was found with citalopram relief and improvement in intens Studies were identified by searching (P = 0.68). Studies on migraine head- patients who received zimelidine MEDLINE (1966 to 1997) using the ache had conflicting results. 1 study oxetine, or amitriptyline comparec keywords pain, neuropathy, migraine, found that fluoxetine improved head- placebo (P < 0.05). Fluoxetine sh fibromyalgia, serotonin uptake inhibi- ache scores compared with placebo greater pain relief than amitripi tors, sertraline, paroxetine, fluoxetine, (P < 0.05), whereas another found that (P< 0.001). fluvoxamine, femoxetine, zimelidine, it had no benefit. 2 placebo-controlled and citalopram. Additional studies studies of femoxetine showed no im- Conclusion were identified by searching bibliog- provement compared with placebo; Selective serotonin reuptake ir raphies of review articles and by con- however, in 1 study of femoxetine and tors are effective for mixed ch tacting manufacturers of SSRIs. propranolol, both drugs showed equal pain, but it is unclear whether improvement from baseline (P< 0.001). are beneficial for tension heads Study selection A trial comparing fluvoxamine and low- migraine, diabetic neuropathy Studies were selected if they were ran- dose amitriptyline found both drags to fibromyalgia. domized, double-blind, controlled show similar improvement, but patients Source of funding: No external fundin trials done on humans and published who received fluvoxamine had fewer For article reprint: Dr. A.C. Jung, L in English. side effects. 3 studies that evaluated 83 mem of Medicine Residency Offiahttp://ebm.bmj.com/ patients with diabetic neuropathy also Data extraction 356421, University of Washington, t had conflicting results. 1 study found no Data were extracted on study design; WA 98195, USA. difference between fluoxetine and pla- type of pain, including headache, cebo for pain reduction (P=0.34). How- Abstract and Commentary also publis chronic pain, neuropathy, and fibro- ACP Journal Club. 1998;i28:3. on October 2, 2021 by guest. Protected copyright. Commentary This important review by Jung and col- Treatment of chronic pain usually in- References leagues about the efficacy of SSRIs in pa- volves a muitidisciplimry approach, and 1. "fhase ME. Do we really need all th< tients with chronic pain may be limited by antidepressants are rarely prescribed in anu'depressants? Weighing the options publication bias and the varied group of isolation. The interaction of different deal Psychiatry Behav Health. 1997;3: conditions it covers. However, for clini- treatments may produce more clinically 2. Harrison S, Glover S, Feinma Pearce C, Harris M. A comparison cians who use SSRIs to treat patients with relevant results (2). The debate concern- depressant medication alone and in « chronic pain, the review validates their use ing the use of SSRIs is complicated and tion with cognitive behaviour then in some defined groups. Further, accumu- influenced by many factors, not the least chronic idiopathic facial pain. In: jeiv lating evidence suggests that SSRIs are of which is financial barriers (1). Turner JA, Wiesenfield Z, eds. Pro; better tolerated than tricyclic antidepres- Charlotte Feinmami, MD Pain Research and Management. Pi sants (1) and may be preferred by patients ings of the 8th World Congress on P= Eastman Dental institute Seattle: IASP Press; 1997:663-72. and prescribers alike. London, England, UK 12 tcs Evidence-Based Medicine January/Februc.
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