Objective To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition. Design Overview of systematic reviews. Data sources PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to 20 June 2022. Eligibility criteria for selecting studies Systematic reviews comparing any antidepressant with placebo for any pain condition in adults. Data extraction and synthesis Two reviewers independently extracted data. The main outcome measure was pain; for headache disorders it was frequency of headaches. Continuous pain outcomes were converted into a scale of 0 (no pain) to 100 (worst pain) and were presented as mean differences (95% confidence intervals). Dichotomous outcomes were presented as risk ratios (95% confidence intervals). Data were extracted from the time point closest to the end of treatment. When end of treatment was too variable across trials in a review, data were extracted from the outcome or time point with the largest number of trials and participants. Secondary outcomes were safety and tolerability (withdrawals because of adverse events). Findings were classified from each comparison as efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the grading of recommendations assessment, development, and evaluation framework. Results 26 reviews (156 unique trials and >25 000 participants) were included. These reviews reported on the efficacy of eight antidepressant classes covering 22 pain conditions (42 distinct comparisons). No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. 11 comparisons (nine conditions) were found where antidepressants were efficacious, four with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain (mean difference −5.3, 95% confidence interval −7.3 to −3.3), postoperative pain (−7.3, −12.9 to −1.7), neuropathic pain (−6.8, −8.7 to −4.8), and fibromyalgia (risk ratio 1.4, 95% confidence interval 1.3 to 1.6). For the other 31 comparisons, antidepressants were either not efficacious (five comparisons) or the evidence was inconclusive (26 comparisons). Conclusions Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions. Systematic review registration PROSPERO CRD42022311073. No additional data available.

中文翻译：

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抗抑郁药治疗成人疼痛的功效、安全性和耐受性：系统评价概述


目的 全面概述抗抑郁药根据病情治疗疼痛的有效性、安全性和耐受性。系统评价的设计概述。数据来源 PubMed、Embase、PsycINFO 和 Cochrane 对照试验中央注册库，时间从开始到 2022 年 6 月 20 日。 选择研究的资格标准 对成人任何疼痛状况比较任何抗抑郁药与安慰剂的系统评价。数据提取和合成 两名评审员独立提取数据。主要结果指标是疼痛；对于头痛疾病，则是头痛的频率。持续疼痛结果被转换为 0（无疼痛）至 100（最严重疼痛）的等级，并以平均差（95% 置信区间）的形式呈现。二分结果以风险比（95% 置信区间）的形式呈现。数据是从最接近治疗结束的时间点提取的。当评价中各试验的治疗结束变化太大时，数据是从试验和参与者数量最多的结果或时间点提取的。次要结局是安全性和耐受性（因不良事件而退出）。每次比较的结果都被分为有效、无效或不确定。通过建议评估、制定和评估框架的分级来评估证据的确定性。结果 纳入 26 条评价（156 项独特试验和 >25 000 名参与者）。这些评论报告了八种抗抑郁药物的疗效，涵盖 22 种疼痛状况（42 种不同的比较）。没有任何评论提供关于抗抑郁药对任何病症的疼痛功效的高确定性证据。 发现抗抑郁药有效的 11 项比较（9 种情况），其中 4 项具有中等确定性证据：血清素去甲肾上腺素再摄取抑制剂 (SNRI) 治疗背痛（平均差 -5.3，95% 置信区间 -7.3 至 -3.3）、术后疼痛（ -7.3、-12.9 至 -1.7）、神经性疼痛（-6.8、-8.7 至 -4.8）和纤维肌痛（风险比 1.4，95% 置信区间 1.3 至 1.6）。对于其他 31 项比较，抗抑郁药要么无效（5 项比较），要么证据不明确（26 项比较）。结论 在本次系统评价概述中包含的 42 项比较中，有 11 项发现了抗抑郁药疗效的证据——11 项比较中有 7 项调查了 SNRI 的疗效。对于其他 31 项比较，抗抑郁药要么无效，要么疗效证据尚无定论。研究结果表明，在针对疼痛情况开抗抑郁药时需要采取更细致的方法。系统审评注册PROSPERO CRD42022311073。没有其他可用数据。