澳大利亚悉尼大学Giovanni E Ferreira团队研究了抗抑郁药治疗成人疼痛的疗效、安全性和耐受性。2023年2月1日，《英国医学杂志》发表了这一成果。
为了根据病情提供抗抑郁药治疗疼痛的疗效、安全性和耐受性的全面综述，研究组从PubMed、Embase、PsycINFO和Cochrane对照试验中央登记处检索从成立到2022年6月20日的相关文献，筛选出对成人任何疼痛状况进行抗抑郁药与安慰剂的系统评价，并进行系统评价概述。
由两名评审员独立提取数据。主要结局指标是疼痛；对于头痛障碍为头痛频率。持续疼痛结果被转换为0（无疼痛）至100（最严重疼痛）的等级，并以平均差异（95%置信区间）表示。二分结果以风险比表示。从最接近治疗结束的时间点提取数据。
当在一项研究中，不同试验的治疗结束时间变化太大时，从试验和参与者最多的结果或时间点提取数据。次要结局是安全性和耐受性（因不良事件退出）。每次比较的结果被分类为有效、无效或不确定。证据的确定性通过建议评定、开发和评估框架的分级进行评估。
该研究共包括26次审查（156次独特试验和>25000名参与者）。这些综述报告了涵盖22种疼痛状况的8种抗抑郁药物的疗效（42种不同的比较）。没有任何综述提供抗抑郁药对任何情况下疼痛疗效的高确定性证据。
11项比较（9种情况）发现抗抑郁药有效，4项具有中等确定性证据：5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）用于背痛（平均差异−5.3）、术后疼痛（−7.3）、神经性疼痛（−6.8）和纤维肌痛（风险比1.4），抗抑郁药要么无效（5项比较），要么证据不确凿（26项比较）。
在该系统综述中的42项比较中，有11项发现了抗抑郁药疗效的证据。11项比较中有7项调查了SNRI的疗效。在其他31项比较中，抗抑郁药要么无效，要么疗效证据不确定。研究结果表明，在为疼痛状况开具抗抑郁药时，需要更细致的方法。
附：英文原文
Title: Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews
Author: Giovanni E Ferreira, Christina Abdel-Shaheed, Martin Underwood, Nanna B Finnerup, Richard O Day, Andrew McLachlan, Sam Eldabe, Joshua R Zadro, Christopher G Maher
Issue&Volume: 2023/02/01
Abstract:
Objective To provide a comprehensive overview of the efficacy, safety, and tolerability of antidepressants for pain according to condition.
Design Overview of systematic reviews.
Data sources PubMed, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to 20 June 2022.
Eligibility criteria for selecting studies Systematic reviews comparing any antidepressant with placebo for any pain condition in adults.
Data extraction and synthesis Two reviewers independently extracted data. The main outcome measure was pain; for headache disorders it was frequency of headaches. Continuous pain outcomes were converted into a scale of 0 (no pain) to 100 (worst pain) and were presented as mean differences (95% confidence intervals). Dichotomous outcomes were presented as risk ratios (95% confidence intervals). Data were extracted from the time point closest to the end of treatment. When end of treatment was too variable across trials in a review, data were extracted from the outcome or time point with the largest number of trials and participants. Secondary outcomes were safety and tolerability (withdrawals because of adverse events). Findings were classified from each comparison as efficacious, not efficacious, or inconclusive. Certainty of evidence was assessed with the grading of recommendations assessment, development, and evaluation framework.
Results 26 reviews (156 unique trials and >25000 participants) were included. These reviews reported on the efficacy of eight antidepressant classes covering 22 pain conditions (42 distinct comparisons). No review provided high certainty evidence on the efficacy of antidepressants for pain for any condition. 11 comparisons (nine conditions) were found where antidepressants were efficacious, four with moderate certainty evidence: serotonin-norepinephrine reuptake inhibitors (SNRIs) for back pain (mean difference 5.3, 95% confidence interval 7.3 to 3.3), postoperative pain (7.3, 12.9 to 1.7), neuropathic pain (6.8, 8.7 to 4.8), and fibromyalgia (risk ratio 1.4, 95% confidence interval 1.3 to 1.6). For the other 31 comparisons, antidepressants were either not efficacious (five comparisons) or the evidence was inconclusive (26 comparisons).
Conclusions Evidence of efficacy of antidepressants was found in 11 of the 42 comparisons included in this overview of systematic reviews—seven of the 11 comparisons investigated the efficacy of SNRIs. For the other 31 comparisons, antidepressants were either inefficacious or evidence on efficacy was inconclusive. The findings suggest that a more nuanced approach is needed when prescribing antidepressants for pain conditions.
DOI: 10.1136/bmj-2022-072415
Source: https://www.bmj.com/content/380/bmj-2022-072415
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
