Rethinking use of medicines for chronic pain

Despite spectacular advances in the neuroscience of chronic pain since the early 2000s, successful medical interventions remain elusive. The timely linked overview of systematic reviews by Ferreira and colleagues (doi:10.1136/bmj-2022-072415) adds to the body of evidence on the use of medicines for pain.1

In its most recent guidance on chronic pain, the UK National Institute for Health and Care Excellence evaluated the benefits and harms of medicines used for chronic primary pain (pain not adequately explained by any underlying condition).2 Antidepressants are the only drugs where this balance proved favourable, and NICE recommended clinicians “consider” their use because of the current gaps in evidence.

Ferreira and colleagues explored the effectiveness of antidepressants in a wider range of chronic pain conditions. They reported that just 11 of 42 comparisons—in nine of 22 chronic pain conditions—showed some evidence of effectiveness, but none of this evidence was of high quality. Their findings suggest that for most adults living with chronic pain, antidepressant …