This article comes to you a little later than DW’s Science team had planned. The day I was originally supposed to write about the connection between and , my hands and wrists hurt so much, I couldn’t type for longer than a few minutes at a time. Ah, the irony.
Thankfully, the pain mostly retreated over the course of a weekend. In the past, I’ve had to take time off work for weeks as typing, or any activity that involved using my hands, became nigh impossible.
As for the source of that pain? That’s a mystery none of the over the years have been able to solve.
But my case is common: While we don’t know the exact number of people living with chronic pain globally, in the so-called Western world, roughly 20% of adults deal with it. That’s according to the International Association for the Study of Pain (IASP).
The IASP defines as “a condition in which an individual experiences pain on most days or every day for more than three months.”
If the pain significantly impacts your daily life, such as when you cannot cook meals, play your favorite sport or write an article anymore, IASP classifies the condition as “high-impact chronic pain”.
When chronic pain is so bad, you’ll try almost anything
If you or one of your loved ones is a member of this sh*tty club, it’s likely you have found yourself at some point, where I reached about a year ago — I was willing to do almost anything to make the pain go away.
I’d had various x-rays and MRIs of my wrists, arms, cervical- and thoracic spine, and a rheumatism test, all of which came back with an all-clear. I had experimented with various kinds of physical therapy, osteopathy and acupuncture.
That’s how I ended up sitting across from a pain therapist, nodding “yes” emphatically in reply to their question, “Would you consider trying antidepressants?”
The question does not land well with everyone.
“A lot of patients feel insulted,” said Tamar Pincus, dean of the faculty of environmental and life sciences at the University of Southampton, UK, in an interview with DW. “They think their doctor is implying that the pain is only in their mind.”
Antidepressants to treat chronic pain? I’m not depressed!
Pincus said that over time, regular pain medication tends to stop working. So, she and other researchers in the field have looked for alternative solutions.
And there are several logical reasons why they have looked at antidepressants as an alternative to conventional pain medicine. One of them is that chronic pain can affect a person’s mood or mental health.
“A large proportion of people who live with chronic pain, around 40%, are in a low mood,” said Pincus. “They’re not clinically depressed. But they feel guilty for not pulling their weight at work or at home, and they often can’t do what they want to or love to do.”
Antidepressants, Pincus said, could help with that.
But they could also help with the pain itself. The chemicals that antidepressants regulate in the brain, such as serotonin and noradrenaline, affect both mood and pain.
“The areas that involve processing pain in our brain are close to those that process negative emotions,” said Pincus.
So, it makes sense to think that the same drugs used to treat depression may also ease chronic pain. But research by Pincus and colleagues does not appear to support the idea.
Trials on antidepressants and chronic pain are unreliable
In cooperation with Cochrane, a global network for health data review, researchers from the University of Southampton analyzed findings from 176 scientific trials on antidepressants and chronic pain. The trials involved about 30,000 patients and 27 different antidepressants.
Their review of the results was sobering: The trials on the effect of antidepressants on chronic pain appeared so small, and yielded such poor data across the trials, that they only felt confident about the efficacy of a single one of the 27 antidepressants that were tested, and that was duloxetine.
Another drug, known as amitriptyline, did not pass the test at all.
But amitriptyline is the antidepressant most commonly prescribed against chronic pain in the , and — and it’s one of the two drugs I have been taking for almost a year.
None of the amitriptyline trials they reviewed had involved a sufficient number of participants for them to be considered reliable.
That doesn’t mean amitriptyline is totally ineffective against chronic pain. During our interview, I told Pincus that my symptoms had started to improve dramatically after I had taken amitriptyline for about four weeks, and that I’d been sleeping a lot better as well. Pincus wasn’t at all surprised to hear it.
“We work with evidence built on groups,” said Pincus. “We cannot predict how an individual experiences medicine. Amitriptyline, a type of antidepressant called tricycles, can have pretty nasty side effects, like making people sleepy.”
That worked out well for me, as an individual — perhaps I got lucky. But at the group level, the researchers found low overall efficacy and a high likelihood of side effects for the drug. And that is not a good thing when you are trying to evaluate whether a medicine can offer good treatment to the largest number of people.
The best advice for chronic pain: ‘Live life to the fullest’
Even duloxetine, which appeared to indeed reduce pain and increase people’s ability to return to day-to-day activities, showed only short-term effectiveness. And there was little data on any side effects, or the harm the drug causes, if at all, when taken long-term.
“The results were promising, but [the lack of information on potential damage] worries me,” said Pincus.
But, then, as we wound up our conversation, Pincus, who has her own personal experience with chronic pain, left me with advice about perhaps the most natural alternative to medication.
“Live life to the fullest extent that you can,” she said. “Be adventurous with your creativity! When you do that, the synapses in your brain change. Any kind of activity that brings you joy, helps you live with chronic pain.”
Edited by: Zulfikar Abbany
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