If you've gone to the doctor for back pain, you likely left with a prescription for some type of medication. People with recurring or chronic back pain are often prescribed antidepressants.
antidepressants are thought to be effective in treating pain because they increase the amount of neurotransmitters in the brain that decrease negative feelings like pain - both physically and mentally. Also, many people with chronic pain also experience depression, either due to the shared areas of the brain that process both physical and emotional pain or to the situational reduction of quality of life experienced by many with chronic pain. While using medication to target both conditions may seem sound, arguments against the use of antidepressants to treat chronic pain have been mounting for over a decade.
antidepressants don't cure the cause of back pain; when they work, they may simply mask the sensation of pain. These drugs are generally prescribed to people with nonspecific, or undiagnosed, back pain in lieu of treatments that address the unknown cause of pain.
Do They Work?
antidepressants were designed to affect brain chemistry as they do because it is hypothesized that abnormal brain chemistry, including a deficiency of key neurotransmitters, is one of the causes of clinical depression. While these drugs have shown to improve the lives of people with severe, clinical depression, they have not shown consistent results for people with chronic back pain. A number of studies have been done in recent decades to assess the use of these drugs for the treatment of various conditions. While some studies show that they can relieve back pain, others show that they are no better than placebos. The unpredictability of the effects are enough to make prescription of antidepressants for back pain questionable, yet they continue to be prescribed en masse.
Researchers for the Cochrane Library reviewed 10 trials that compared anti-depressant effects and placebo effects on people with back pain. They found that there was no difference in pain reduction between the medication and the placebo group in many studies and, at best, conflicting evidence in others. Review the study at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001703.pub3/abstract.
Risks
Even if an anti-depressant could relieve your back pain, there are risks of both short- and long-term use that must be considered. At first, they may cause hyper-alertness or the opposite, a sedated state. Other symptoms such as constipation, dry mouth, nausea, insomnia and headache are common. These may decrease as your brain gets used to the new situation.
Long-term use of these drugs comes with additional side effects. Weight gain and loss of libido are common, particularly in women. Abrupt cessation of SSRI drugs has been linked to nausea and dizziness. Some medical professionals warn against abrupt cessation of any anti-depressant for fear of psychological and physical withdrawal symptoms, while others maintain that there is no concern.
Aside from physical symptoms, long-term use of these medications can have a negative impact on you psychologically. One concern is tolerance; as the brain gets used to the drug's effects, the body may begin to perform processes to oppose it. This means that the drug ceases to be effective as the brain gets better at creating a ripe environment for depression. Recurrent depressive episodes and worsening of symptoms are possible. This poses a concern particularly for people with chronic pain and depressive symptoms. For those being treated for pain exclusively, drugs are generally administered at lower doses and may or may not produce psychological side effects. However, dosages increase as physical tolerance builds up. See http://www.huffingtonpost.com/dr-peter-breggin/antidepressants-long-term-depression_b_1077185.html for more on tolerance and adverse effects.
The most frightening part of this discussion of risks associated with long-term anti-depressant use is that it is incomplete. antidepressants saturated the market before long-term studies were done to confirm their safety. It was only after years of use by children and teens that, in 2004, the FDA announced that anti-depressant use can increase the risk of suicidal tendencies in young people. While these drugs can improve the lives of people with severe, chronic depression, their use by people with mild depression, chronic back pain or both is unsubstantiated; the risks may outweigh the benefits.
Alternatives
One main way to avoid anti-depressant use for chronic back pain is to find the cause of your pain and seek treatments that address it. A few commonly undiagnosed causes of pain are muscle imbalance, myofascial pain syndrome and sacroiliac joint dysfunction. Researching all possible causes of your pain and finding an open-minded doctor who will hear you out are the first steps to obtaining an accurate diagnosis.
For people with depression, there are ways to alter brain chemistry naturally. Diet, exercise and talk therapies like cognitive behavioral therapy have proven to do so. Cognitive behavioral therapy techniques can even be learned online for free.
Chronic back pain and depression don't destine you to a life of pills. Knowing the evidence, risks and alternatives associated with anti-depressant use for back pain can help you make informed decisions about your treatment.
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