An antidepressant drug can play a key role in alleviating pain from osteoarthritis and may result in fewer side effects than traditionally painkillers, such as anti-inflammatories and opioids, according to a study published online in the International Journal of Clinical Practice. Nearly 27 million Americans suffer from osteoarthritis, a painful condition caused by a loss of cartilage and the degradation of joints.
“It is not uncommon to treat osteoarthritis with a combination of drugs that work in different ways,” said Dr. Leslie Citrome, Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College. “Our review supports this approach and confirms that antidepressants are not just for depression and can play a key role in relieving this painful condition.”
The authors looked at studies exploring the effects of the antidepressant drug duloxetine being used on its own or in combination with non-steroidal anti-inflammatory drugs (NSAIDs). Duloxetine was approved by the Food and Drug Administration (FDA) in 2010 for chronic musculoskeletal pain, including osteoarthritis.
When duloxetine was compared with a placebo, researchers found that, on average, one out of every six patients experienced less pain. That result compares favorably with the pain relief of two NSAID drugs, etodolac and tenoxicam. Duloxetine also had fewer side effects than NSAIDs, which can cause gastrointestinal bleeding, and opiates such as morphine, which can cause constipation.
Researchers also looked at findings of a recent study that showed the potential synergy of duloxetine and NSAIDs. The study, a ten-week double-blind trial of over 500 patients with osteoarthritis of the knee, found that those who took a combination of duloxetine and NSAIDs reported less pain than the control group who took a NSAID with a placebo.
“Although the use of duloxetine as a monotherapy for pain has been approved by the regulatory agencies, it is quite common for patients to receive a combination of drugs and NSAIDs are the most frequently prescribed drugs for the pain associated with osteoarthritis,” said Dr. Citrome. “We believe that our analysis of these studies demonstrate that clinicians managing patients suffering from osteoarthritis should also consider prescribing adjunctive antidepressants that can effectively impact on central pain pathways.”