Cochrane · systematic review · CD014682
Antidepressants for pain management in adults with chronic pain: a network meta‐analysis
Birkinshaw, H, Friedrich, CM, Cole, P, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
Pain, Palliative and Supportive CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
26
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 4 · 13.3%Very low 12 · 40%Low 6 · 20%Moderate 8 · 26.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Substantial pain relief summary of findings
Population: people with chronic pain Interventions: desvenlafaxine high dose (≥ 50 mg); duloxetine low dose (< 60 mg), standard dose (60 mg), and high dose (> 60 mg); esreboxetine standard dose (4‐8 mg) and high dose (≥ 8 mg); milnacipran standard dose (100 mg) and high dose (> 100 mg); mirtazapine standard dose (30 mg) Comparator (reference): placebo Outcome: substantial pain relief (≥ 50% reduction in pain intensity from baseline) as measured on various scales including 0‐10 VAS, 0‐100 VAS, and the Brief Pain Inventory Direction: higher is better (i.e. more people reporting substantial pain relief)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 42 Total participants: 14,626 | no estimate extracted | 42 participants | Ungraded |
Duloxetine standard dose RCTs: 16 Participants: 4490 | no estimate extracted | 16 participants | Moderate |
Duloxetine high dose RCTs: 14 Participants: 3692 | no estimate extracted | 14 participants | Moderate |
Milnacipran high dose RCTs: 1 Participants: 384 | no estimate extracted | 1 participants | Very low Downgraded: imprecision |
Esreboxetine standard dose RCTs: 1 Participants: 828 | no estimate extracted | 1 participants | Low |
Milnacipran standard dose RCTs: 2 Participants: 1298 | no estimate extracted | 2 participants | Low Downgraded: inconsistency |
Mirtazapine standard dose RCTs: 1 Participants: 422 | no estimate extracted | 1 participants | Low Downgraded: imprecision |
Duloxetine low dose RCTs: 6 Participants: 1116 | no estimate extracted | 6 participants | Moderate Downgraded: imprecision, inconsistency |
Esreboxetine high dose RCTs: 1 Participants: 555 | no estimate extracted | 1 participants | Very low Downgraded: imprecision |
Desvenlafaxine high dose RCTs: 2 Participants: 870 | no estimate extracted | 2 participants | Very low Downgraded: imprecision |
Pain intensity summary of findings
Population: people with chronic pain Interventions: duloxetine low dose (< 60 mg), standard dose (60 mg), and high dose (> 60 mg); milnacipran standard dose (100 mg) and high dose (> 100 mg) Comparator (reference): placebo Outcome: change in pain intensity, as measured on multiple scales including 0‐10 VAS, 0‐100 VAS, Brief Pain Inventory, and the Short‐form McGill Pain Questionnaire Direction: lower is better (i.e. a greater reduction in pain intensity)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 50 Total participants: 14,926 | no estimate extracted | 50 participants | Ungraded |
Duloxetine high dose RCTs: 14 Participants: 3683 | no estimate extracted | 14 participants | Low Downgraded: imprecision |
Duloxetine standard dose RCTs: 18 Participants: 4959 | no estimate extracted | 18 participants | Moderate Downgraded: imprecision |
Milnacipran high dose RCTs: 2 Participants: 1670 | no estimate extracted | 2 participants | Low Downgraded: inconsistency |
Milnacipran standard dose RCTs: 4 Participants: 1866 | no estimate extracted | 4 participants | Moderate Downgraded: imprecision |
Duloxetine low dose RCTs: 6 Participants: 1104 | no estimate extracted | 6 participants | Moderate Downgraded: inconsistency |
Mood summary of findings
Population: people with chronic pain Interventions: duloxetine (all doses combined), milnacipran (all doses combined), mirtazapine (all doses combined) Comparator (reference): placebo Outcome: change in mood (depression, anxiety, distress) scores as measured on various scales including the Beck Anxiety Inventory, Beck Depression Inventory, SF‐36 Mental Component Score, and the SF‐36 Mental Health Subscale Direction: lower is better (i.e. a greater reduction of distress, depression, or anxiety)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 38 Total participants: 12,985 | no estimate extracted | 38 participants | Ungraded |
Mirtazapine RCTs: 1 Participants: 406 | no estimate extracted | 1 participants | Low Downgraded: imprecision |
Duloxetine RCTs: 26 Participants: 7952 | no estimate extracted | 26 participants | Moderate |
Milnacipran RCTs: 5 Participants: 3109 | no estimate extracted | 5 participants | Moderate Downgraded: inconsistency |
Adverse events summary of findings
Population: people with chronic pain Interventions: amitriptyline standard dose (25‐75 mg); desvenlafaxine high dose (> 50 mg); duloxetine low dose (< 60 mg), standard dose (60 mg), and high dose (> 60 mg); milnacipran standard dose (100 mg) and high dose (> 100 mg); mirtazapine standard dose (30 mg) Comparator (reference): placebo Outcome: adverse events (as reported per study) Direction: lower is better (i.e. fewer people reporting adverse events)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 93 Total participants: 22,558 | no estimate extracted | 93 participants | Ungraded |
Desvenlafaxine high dose RCTs: 2 Participants: 905 | no estimate extracted | 2 participants | Very low Downgraded: imprecision, inconsistency |
Mirtazapine standard dose RCTs: 2 Participants: 457 | no estimate extracted | 2 participants | Very low Downgraded: imprecision, inconsistency |
Duloxetine standard dose RCTs: 20 Participants: 4998 | no estimate extracted | 20 participants | Very low Downgraded: imprecision |
Milnacipran standard dose RCTs: 8 Participants: 2491 | no estimate extracted | 8 participants | Very low Downgraded: imprecision, inconsistency |
Duloxetine high dose RCTs: 10 Participants: 4000 | no estimate extracted | 10 participants | Very low Downgraded: imprecision |
Duloxetine low dose RCTs: 6 Participants: 1031 | no estimate extracted | 6 participants | Very low Downgraded: imprecision |
Milnacipran high dose RCTs: 7 Participants: 2837 | no estimate extracted | 7 participants | Very low Downgraded: imprecision |
Amitriptyline standard dose RCTs: 10 Participants: 997 | no estimate extracted | 10 participants | Very low Downgraded: imprecision |
Esreboxetine standard dose RCTs: 1 Participants: 783 | no estimate extracted | 1 participants | Very low Downgraded: imprecision, inconsistency |