Should Antidepressants Be Use For Post-Surgical Pain?

Ian Gilron, MD, MSc, FRCPC Director of Clinical Pain Research Professor of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, and Center for Neuroscience Studies Queen's University Kingston General Hospital, Kingston, Ontario, CanadaMedicalResearch.com Interview with:
Ian Gilron, MD, MSc, FRCPC
Director of Clinical Pain Research
Professor of Anesthesiology & Perioperative Medicine,
Biomedical & Molecular Sciences, and
Center for Neuroscience Studies Queen’s University
Kingston General Hospital, Kingston, Ontario, Canada

Medical Research: What are the main findings of the study?

Dr. Gilron: Pain is the most common symptom which prevents recovery from surgery. Even with the best available treatments today, many patients still suffer from moderate to severe pain after surgery.

Antidepressants – drugs used to treat depression – are also proven effective for treating chronic pain due to nerve disease and fibromyalgia. However, there has been much less research on the effects of antidepressant drugs on pain after surgery.

Our group conducted a systematic review of all published clinical trials of antidepressant for post surgical pain.

Slightly more than half of these studies suggested some benefit of these drugs but the details of this review led us to conclude that there is not yet enough evidence to recommend these medications for post surgical pain treatment.

Given the possibility that these medications could be useful treatments for pain after surgery, we believe that future studies of higher scientific quality and which involve larger numbers of patients should be carried out in the hopes of finding safer and more effective treatments for pain after surgery.

Medical Research: Were any of the findings unexpected?

Dr. Gilron: In addition to the many differences between the studies included in this review, several studies also had other problems including too few patients in the study, possibly too low a dose of antidepressant medication and not enough reporting regarding drug safety.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gilron: Taking all the concerns raised from this review, we concluded that the available studies do not yet provide enough evidence to support the recommendation of using antidepressant medications to treat pain after surgery.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gilron:However, since more than half of the studies did suggest benefit, this is enough evidence to inspire future studies which have larger numbers of patients, higher scientific quality and which focus on patients at high risk of severe pain after surgery.

Citation:

Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain: Early Evidence and Recommended Future Directions
Wong, Karen M.D.; Phelan, Rachel M.Sc.; Kalso, Eija M.D., D.Med.Sci.; Galvin, Imelda M.B., Ba.O., Bc.H., M.Sc.; Goldstein, David M.B., B.Ch., B.A.O., M.Sc., F.R.C.P.C.; Raja, Srinivasa M.D.; Gilron, Ian M.D., M.Sc.

Anesthesiology:
September 2014 – Volume 121 – Issue 3 – p 591–608
doi: 10.1097/ALN.0000000000000307

 

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