CHRONIC PAIN / ORIGINAL ARTICLE
Effectiveness of antidepressants in neuropathic pain management: a retrospective, multicenter cross-sectional analysis
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1
1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland
2
Department of Anaesthesiology and Intensive Care Education, Medical University of Warsaw, Poland
3
Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Poland
Submission date: 2025-04-16
Final revision date: 2025-07-21
Acceptance date: 2025-08-03
Publication date: 2025-09-15
Corresponding author
Marcin Kołacz
1st Department of Anaesthesiology
and Intensive Care, Medical University of Warsaw,
4 Lindleya St., 02-005 Warsaw, Poland
Anaesthesiol Intensive Ther 2025;57(1):226-230
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Neuropathic pain (NP) arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system. Antidepressants (ADs) are recommended for the pharmacological treatment of NP. However, current guidelines do not
specify how long ADs may be effective in NP treatment if the patient is benefiting from
the therapy.
Material and methods:
This was a retrospective cross-sectional study aiming to analyze the effectiveness of ADs in the treatment of NP by assessing the relationship between AD usage,
the length of AD treatment and the intensity of pain in this group patients. Based on
their pain intensity and length of treatment, the patients were divided into: three groups
(NRS 0–3, NRS 4–6 and NRS ≥ 7), and six groups (< 1 month, 1–3 months, 3–6 months,
6–12 months, 1–2 years, 2–5 years, and > 5 years), respectively.
Results:
The study was conducted on a database from 421 patients, 231 (54.86%)
of whom took antidepressants. We found that AD treatment significantly reduces the likelihood of being in the NRS 7–10 group compared to the NRS 0–3 group
(OR = 0.611, 95% CI: 0.37–1.0, P = 0.05), and this reduction was observed up to
24 months of treatment (OR = 0.41, 95% CI: 0.22–0.75, P < 0.004).
Conclusions:
Considering the limitations of the study, the use of ADs in NP therapy may
have a significant impact on reducing the occurrence of severe pain up to 24 months
of therapy and should be included in pharmacotherapy in this group of patients.
REFERENCES (29)
1.
Bouhassira D. Neuropathic pain: definition, assessment and epidemiology. Rev Neurol (Paris) 2019; 175: 16-25.
2.
Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, et al. Neuropathic pain. Nat Rev Dis Prim 2017; 3: 17002. DOI: 10.1038/nrdp.2017.2.
3.
Attal N. Pharmacological treatments of neuropathic pain: the latest recommendations. Rev Neurol (Paris) 2019; 175: 46-50. DOI: 10.1016/ j.neurol.2018.08.005.
4.
Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015; 14: 162-173. DOI: 10.1016/S1474-4422(14)70251-0.
5.
Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114: 29-36. DOI: 10.1016/j.pain. 2004.12.010.
7.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63 Suppl 11: S240-S252. DOI: 10.1002/acr.20543.
8.
Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94: 149-158. DOI: 10.1016/S0304-3959(01)00349-9.
9.
Bates D, Carsten Schultheis B, Hanes MC, Jolly SM, Chakravarthy KV, Deer TR, et al. A comprehensive algorithm for management of neuropathic pain. Pain Med (United States) 2019; 20: S2–S12.
10.
Dworkin RH, O’Connor AB, Audette J, Baron R, Gourlay GK, Haanpää ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010; 85: S3-S14. DOI: 10.4065/mcp.2009.0649.
11.
Przeklasa-Muszyńska A, Krajnik M, Janecki M, Woroń J, Zajączkow- ska R, Wordliczek J, et al. Diagnosis and management of neuropathic pain: review of literature and recommendations of the Polish Association for the Study of Pain and the Polish Neurological Society – Part one. Neurol Neurochir Pol 2014; 48: 262-271. DOI: 10.1016/j.pjnns. 2014.07.011.
12.
Moisset X, Bouhassira D, Attal N. French guidelines for neuropathic pain: an update and commentary. Rev Neurol (Paris) 2021; 177: 834-837. DOI: 10.1016/j.neurol.2021.07.004.
13.
Lanie Kremer M, Salvat E, Muller A, Yalcin I, Barrot M. Review antidepressants and gabapentinoids in neuropathic pain: mechanistic insights. Neuroscience 2016; 338: 183-206. DOI: 10.1016/j.neuroscience.2016.06.057.
14.
Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007; 2007: CD005454. DOI: 10.1002/14651858.CD005454.pub2.
15.
Birkinshaw H, Friedrich CM, Cole P, Eccleston C, Serfaty M, Ste- wart G, et al. Antidepressants for pain management in adults with chronic pain: a network meta-analysis. Cochrane Database Syst Rev 2023; 5: CD014682. DOI: 10.1002/14651858.CD014682.pub2.
16.
Sultan A, Gaskell H, Derry S, Andrew RA. Duloxetine for painful diabetic neuropathy and fibromyalgia pain: systematic review of randomised trials. BMC Neurol 2008; 8: 29. DOI: 10.1186/1471-2377-8-29.
17.
Shaygan M, Böger A, Kröner-Herwig B. Predicting factors of outcome in multidisciplinary treatment of chronic neuropathic pain. J Pain Res 2018; 11: 2433-2443. DOI: 10.2147/JPR.S175817.
18.
World Health Organization. Q2: How long should treatment with antidepressants continue in adults with depressive episode/disorder? WHO; 2012.
19.
Kato M, Hori H, Inoue T, Iga J, Iwata M, Inagaki T, et al. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta- analysis. Mol Psychiatry 2021; 26: 118-133. DOI: 10.1038/s41380- 020-0843-0.
20.
Bartova L, Fugger G, Dold M, Kautzky A, Fanelli G, Zanardi R, et al. Real-world characteristics of European patients receiving SNRIs as first-line treatment for major depressive disorder. J Affect Disord 2023; 332: 105-114. DOI: 10.1016/j.jad.2023.03.068.
21.
Kjosavik SR, Gillam MH, Roughead EE. Average duration of treatment with antidepressants among concession card holders in Australia. Aust N Z J Psychiatry 2016; 50: 1180-1185. DOI: 10.1177/ 0004867415621392.
22.
Brett J, Karanges EA, Daniels B, Buckley NA, Schneider C, Nassir A, et al. Psychotropic medication use in Australia, 2007 to 2015: changes in annual incidence, prevalence and treatment exposure. Aust N Z J Psychiatry 2017; 51: 990-999. DOI: 10.1177/0004867417721018.
23.
Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010; 150: 573-581. DOI: 10.1016/j.pain.2010.06.019.
24.
Szczudlik A, Dobrogowski J, Wordliczek J, Stępień A, Krajnik M, Leppert W, et al. Diagnosis and management of neuropathic pain: Review of literature and recommendations of the Polish Association for the study of pain and the Polish Neurological Society – part two. Neurol Neurochir Pol 2014; 48: 423-435. DOI: 10.1016/j.pjnns.2014.11.002.
25.
Boonstra AM, Stewart RE, Albère AJ, René RF, Swaan JL, Schre- urs KMG, Schiphorst Preuper HR. Cut-offpoints for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol 2016; 7: 1466. DOI: 10.3389/fpsyg. 2016.01466.
26.
Wernicke JF, Raskin J, Rosen A, Pritchett YL, D’Souza DN, Iyengar S, et al. Duloxetine in the long-term management of diabetic peripheral neuropathic pain: an open-label, 52-week extension of a randomized controlled clinical trial. Curr Ther Res Clin Exp 2006; 67: 283-304. DOI: 10.1016/j.curtheres.2006.10.001.
27.
Norman TR. Book Review: Therapeutic Guidelines: Psychotropic. Aust N Z J Psychiatry 2001; 35: 549-550. DOI: 10.1046/j.1440-1614. 2001.0917c.x.
28.
Murnion BP. Neuropathic pain: current definition and review of drug treatment. Aust Prescr 2018; 41: 60-63. DOI: 10.18773/austprescr. 2018.022.
29.
Farber MD. Designing Clinical Research; 1990; Vol. 10; ISBN: 9780781782104.