Back pain and osteoarthritis affect millions of people across the globe and is a leading cause of disability. Most commonly, paracetemol and ibuprofen are prescribed as a first-line treatment, but when this fails people can be prescribed antidepressants for their pain. More people are prescribed antidepressants for pain than opioids, and are often recommended for the treatment of chronic back pain and hip and knee osteoarthritis. In the UK, 16% of prescriptions for antidepressants in children and adults are for pain, and this number tripled in the space of eleven years.
A systematic review looked into the effectiveness of using antidepressants for back pain and osteoarthritis. Results revealed the effect of Selective Non-Serotonin Reuptake Inhibitors (SNRIs) on back pain is small and not clinically important, but more positive effects may be significant for osteoarthritis. Tricyclic Antidepressants (TCAs) and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low, with the added risk of adverse events.