Chronic pain touches millions worldwide, and many people rely on antidepressants to manage it. Yet the latest evidence questions how well these medicines work for persistent pain. Researchers summarized the landscape in a comprehensive review and highlighted the key takeaways for clinicians and patients alike.
Global estimates show that about one in five people live with chronic pain. Antidepressants are a common prescription in many health systems for this condition, but new findings indicate that only one specific drug shows reliable benefit in reducing pain for some patients. The breadth of the analysis helps clarify which treatments may be worthwhile and where uncertainty remains.
The study compiled data from 178 individual investigations, encompassing around 28,000 participants. This large-scale assessment represents the most extensive synthesis to date on how antidepressants perform against chronic pain, providing a clearer picture of potential benefits and limitations.
Across 43 separate studies involving more than 11,000 people, duloxetine emerged as the only antidepressant with a consistent, moderate effect on pain relief. In addition to easing discomfort, there is evidence that duloxetine may help improve mobility for people living with chronic pain. Importantly, a 60 milligram dose was found to be as effective as a higher 120 milligram dose in the contexts examined.
Evidence for the pain-relieving effects of amitriptyline, citalopram, fluoxetine, paroxetine, and sertraline was rated as low quality. This suggests that conclusions about their ability to ease pain cannot be drawn definitively from the available data. It is also notable that nearly 16 million prescriptions for amitriptyline were written in 2023, underscoring how frequently this drug is used in routine practice for a range of conditions, sometimes including pain management.
The researchers emphasized that depression treatment guidelines should be kept in mind when interpreting these results. Because amitriptyline is no longer routinely recommended for depression, it is plausible that a substantial portion of its recent prescriptions may have been driven by pain relief considerations rather than mood stabilization alone.
These insights have influenced new treatment recommendations in the United Kingdom. Duloxetine is now advised for chronic primary pain, which describes pain without a clearly identifiable cause, and for pain linked to disorders of the nervous system. The intent is to guide clinicians toward therapies with the strongest, most reliable evidence while acknowledging individual patient variation.
At the same time, the authors stress that pain is a uniquely personal experience. Even when overall evidence is limited or inconclusive, some people may experience meaningful benefit from specific medications. The practical takeaway is that treatment should be tailored and discussed in the context of each patient’s symptoms, expectations, and overall health status.
Beyond pharmacologic options, the article notes that researchers have explored nonpharmacological approaches to easing pain. For instance, a recent line of work has documented a 20-minute procedure that shows promise for reducing lower back pain, highlighting the importance of a multimodal strategy that combines medication with lifestyle changes and supportive therapies.