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These Anti-11 comparisons (nine conditions) found that antidepressants were efficacious in four cases with moderate certainty of evidence. serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain relief.
What About?
The 2021 National Institute for Health and Care Excellence guideline for chronic primary pain explicitly recommends against using pain medicines except for antidepressants. 1314 Chronic immediate pain is a recent diagnostic classification encompassing many conditions, such as fibromyalgia, complex regional pain syndrome, orofacial pain, visceral pain (e.g., irritable bowel syndrome, bladder pain), and musculoskeletal pain (e.g., back pain). 15 Other types of pain, such as postsurgical, neuropathic, and cancer-relat, are not classify under chronic primary pain, but the efficacy of antidepressants for these conditions has investigated.16171819 To provide patients and clinicians with an updated cancer-related painive resource on the efficacy, safety, and tolerability of antidepressants to treat pain, we conducted an overview of investigated. steamatic reviews. review and read the full texts of all eligible studies. Consensus was use to resolve the disagreements. Supplementary File 2 provides a list after reading the entire text.
Eligibility criteria
We included systematic review articles, with or without a meta-analysis published in peer-reviewed journals, that compared antidepressant drugs prescribed to adults for pain with a placebo. We defined systematic reviews as peer-reviewed, clearly stated studies that used systematic methods to search the literature and synthesise data. As long as there was an English translation, we did not limit the language or the antidepressant regimen. We only considered network meta-analyses with direct comparisons of antidepressants or placebos (to eliminate indirect comparisons). We excluded reviews that involved children or adolescents, or both, or that did not report pain or safety data. When there were multiple reviews, we chose the most comprehensive. This review included all the trials that were relevant to our comparison (antidepressants versus placebo). We chose Cochrane Reviews when they included the same trials that a non-Cochrane Review had because they tend to be of higher quality. 21 22 The two authors reached a consensus on the inclusion of reviews. In accordance with Cochrane’s recommendations, no new systematic reviews or trial-level searches were conduct within the overview.
Data extraction
Two independent reviewers (GF and JZ) independently extracted the data. Data was extract to determine the characteristics of the review, information about the antidepressant, and the treatment regimen. The data was extract for characteristics of the review, such as prospective registration or non-Cochrane reviews, information on antidepressants and treatment regimens (e.g.,
Results
Pain was the primary outcome that we measured. It can be assess using any instrument. The results were report as the difference between groups, along with 95% confidence intervals. Reported the 95% confidence intervals for mean differences on a standard scale from 0 to 100. We converted dichotomous data to 95% confidence intervals or risk ratios if necessary. We examined the review data to see if we could convert the standardised mean difference to a mean difference on a 0-100 scale. When multiple outcomes were available, we chose the primary outcome of pain. When multiple time points within a review were available, we extracted data on pain outcomes. In more than half of the trials, this was the case. We extracted data from studies on headache disorders based on the frequency of headaches based on guidelines for drug trials in chronic headaches.
Safety outcomes
Safety outcomes were consider secondary outcomes. We didn’t extract data on specific adverse events but rather on any adverse event (e.g., We did not include data on withdrawals due to adverse events, as we anticipated too many variations in the way these events were report. We didn’t include data about severe adverse effects because the majority of trials included in eligible reviews did not have enough power to detect significant differences between groups. When
Two reviewers independently used the AMSTAR-2 tool to evaluate the quality of the methodological assessment. The tool has 16 items, of which 7 are consider critical. The 28-point scale was use to rate the quality of the systematic reviews includ. They were rate as high, moderate, low, or critically low.
We assessed bias by using the previously described criteria. We look at trials that classify the industry ties for each test, including the The Supplementary File 4 contains all of the problems that have been identify.
Proof of certainty
The original confidence in the evidence was sit high. We did not raise the level of trust. The Supplementary File 5 gives a detailed explanation.
Data Synthesis
Presented the data both inside and outside. We calculated median doses (from minimum to maximum). We calculated the median (maximum to minimal). In the following cases, we reanalyzed the data.
The random effect model is less strict in terms of consistency between studies. The safety results were report as describe in Supplementary File 6, which describes which reviews we calculated the overlap from and creat a table of citations.
Each comparison was classified as productive or unproductive. The antidepressant was deeme adequate when the difference between the placebo and intervention groups was not.
This decision was take because of the widespread use of points, e.g.
Analysis of Sensitivity
This analysis includ systematic reviews that exclud due to the five years chose because it is recommend that systematic reviews updat every five years. This analysis includ systematic reviews that were exclud because the five-year period was chose because it is recommend to update systematic reviews every five years.
Protocol deviations
In our protocol, we stated that we would collect secondary data about disabilities and serious adverse events. We did not extract disability data, as it became evident when we extracted the data that many reviews lacked data. We also did not extract data on serious adverse events because most studies included in each review did not have the power to detect them.
In the protocol, we specified that, for reviews reporting multiple data points, the primary endpoint would be 3–12 months (or the period closest to 6 months if different time points are present within this timeframe). The team agreed it was not appropriate to define the intermediate term (3–12 months) as the primary outcome for this review. The team agreed that defining the intermediate term (3–12 months) as the primary endpoint was inappropriate for this review. This was due, among other things, to a number of factors. Most studies reported only one measure after treatment, and treatment phases are typically 6–12 weeks long. It would have been harmful to extract data from six-month reviews in reviews that include data at different time points, such as three months, six months, and one year. This would make the data less comparable with other reviews. This would lead to fewer tests being includ. We determined that the best way to do this was to only extract data from the latest time point (>50%) for most of the tests included in the review.
Both patients and the public have a stake in this.
A lack of funding prevented patients and members of the public from being involve in the design, execution, or reporting of the study.
