{"id":866,"date":"2021-01-26T13:56:08","date_gmt":"2021-01-26T18:56:08","guid":{"rendered":"http:\/\/myuprightlife.com\/?p=866"},"modified":"2021-01-26T13:56:11","modified_gmt":"2021-01-26T18:56:11","slug":"can-antidepressants-treat-sciatica","status":"publish","type":"post","link":"https:\/\/myuprightlife.com\/index.php\/2021\/01\/26\/can-antidepressants-treat-sciatica\/","title":{"rendered":"Can Antidepressants Treat Sciatica?"},"content":{"rendered":"\n

I can certainly understand how a bad case of sciatica could cause a person to spiral into depression. But until recently, it never occurred to me that antidepressants could be prescribed as painkillers. But a recently published review<\/a> in BMJ<\/em> pointed out how widespread the practice is \u2013 and how effective antidepressants are at treating sciatica and back pain. (Spoiler: Not very.)<\/p>\n\n\n\n

The authors of the study synthesized data from 33 separate studies to ascertain how well different classes of antidepressants treated three common health concerns: back pain, sciatica, and knee osteoarthritis. (I\u2019m going to focus on the first two.)<\/p>\n\n\n\n

They considered two measures: 1) How antidepressants influenced pain scores, and 2) How antidepressants influenced disability scores. Both were measured on a scale of 0\u2013100.<\/p>\n\n\n\n

Antidepressants: The New Aspirin<\/h2>\n\n\n\n

When my sciatica first became unmanageable back in 2017, I made regular treks to doctors\u2019 offices. The doctors would inform me of my pharmaceutical options in such a way that I would inevitably pick their favorite pill. Yet, none of them ever mentioned antidepressants. So I was surprised to learn just how often antidepressants are prescribed for chronic pain relief.<\/p>\n\n\n\n

The authors of the study (based in Australia) pointed out that 7.2 million Brits were prescribed antidepressants, while 5.6 million were prescribed opioids in a single year (the data covered the final three quarters of 2017, and the first quarter of 2018). In the US, more than a quarter of people with chronic low back pain are given antidepressants.<\/p>\n\n\n\n

And no wonder \u2013 medical societies explicitly endorse their use for these purposes. A separate review<\/a> of clinical practice guidelines found that 80% (8 out of 10) of the guidelines recommended antidepressants to treat low back pain.<\/p>\n\n\n\n

For the record, 87% of the guidelines (13 out of 15) considered recommended using opioids, at least in some circumstances.<\/p>\n\n\n\n

A Refresher on Statistics<\/h2>\n\n\n\n

In case you spent your high school math classes staring at the back of your crush\u2019s head, rather than focusing on the chalkboard, here\u2019s a quick review of the statistics concepts you need to interpret these study results.<\/p>\n\n\n\n

The researchers reported the mean (or average) difference in pain and disability levels on a 100-point scale. For example, let\u2019s say 100 patients suffered from back pain at the start of a study. The average pain score they reported at the beginning of the study was 85. Then, after taking some pain medicine, their average pain score dropped to 60. In this case, the mean difference would be -25 (because 60 \u2013 85 = -25).<\/p>\n\n\n\n

The researchers also listed the 95% confidence interval range. This means that if a person meeting the criteria was selected from the population at large, there is a 95% chance that their pain reduction would be in the same range.<\/p>\n\n\n\n

Using the example above, let\u2019s say that the 95% confidence interval listed was -35 to -15. This means that if we selected a random person with back pain and gave them the medication, there is a 95% chance that they would report a reduction in pain somewhere between -35 and -15 points.<\/p>\n\n\n\n

You may notice that the range is \u00b110 points from our mean of -25. The mean will always be at the exact center of the confidence interval.<\/p>\n\n\n\n

Because this study is looking at pain relief, big negative numbers are good. -35 means greater pain relief than -15. A positive number is bad, because it means pain levels actually increased.<\/p>\n\n\n\n

The authors considered the smallest clinically meaningful difference to be -10.<\/p>\n\n\n\n

\"A
When reading statistics textbooks, you want Ritalin, not antidepressants.<\/figcaption><\/figure>\n\n\n\n

Types of Antidepressants<\/h2>\n\n\n\n

The authors of this study looked at six different classes of antidepressant drugs. Here\u2019s a primer, in case you\u2019re not a pharmacology expert.<\/p>\n\n\n\n

  1. Serotonin-noradrenaline reuptake inhibitors (SNRIs):<\/strong> This class of drugs blocks the reuptake of serotonin and norepinephrine, which increases the levels of these neurotransmitters in the brain. They are also sometimes prescribed for treating anxiety or bipolar. SNRIs include: