Evidence map›Paper›PMID 33627178›Full record

SynthesisSystematic reviews2021

Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis.

Michael C Ferraro, Matthew K Bagg, Michael A Wewege, Aidan G Cashin, Hayley B Leake, Rodrigo R N Rizzo, Matthew D Jones, Sylvia M Gustin, Richard Day, Colleen K Loo and 1 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Systematic reviews, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 8 pooled it
4.5field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 8 syntheses or guidelines pooled it, 34 citations in OpenAlex.

  1. Pooled it
  2. Antidepressants for low back pain and spine-related leg pain.The Cochrane database of systematic reviews · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Michael C FerraroCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0003-0563-1832
Matthew K BaggCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia. m.bagg@neura.edu.au.
Michael A WewegeCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0002-3283-2149
Aidan G CashinCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0003-4190-7912
Hayley B LeakeCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0002-0241-873X
Rodrigo R N RizzoCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0002-9624-6210
Matthew D JonesCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0002-5534-755X
Sylvia M GustinCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0002-9613-9845
Richard DayClinical Pharmacology & Toxicology, St. Vincent's Hospital, Sydney, Australia.ORCID 0000-0002-6045-6937
Colleen K LooSchool of Psychiatry, University of New South Wales, Sydney, Australia.ORCID 0000-0003-3267-0554
James H McAuleyCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.ORCID 0000-0002-0550-828X
UNSW Sydney · AUBlack Dog Institute · AUUniversity of South Australia · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAntidepressant medicines are used to manage symptoms of low back pain. The efficacy, acceptability, and safety of antidepressant medicines for low back pain (LBP) are not clear. We aimed to evaluate the efficacy, acceptability, and safety of antidepressant medicines for LBP.

methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov , the EU Clinical Trials Register, and the WHO International Clinical Trial Registry Platform from inception to May 2020. We included published and trial registry reports of RCTs that allocated adult participants with LBP to receive an antidepressant medicine or a placebo medicine. Pairs of authors independently extracted data in duplicate. We extracted participant characteristics, study sample size, outcome values, and measures of variance for each outcome. We data using random-effects meta-analysis models and calculated estimates of effects and heterogeneity for each outcome. We formed judgments of confidence in the evidence in accordance with GRADE. We report our findings in accordance with the PRISMA statement. We prespecified all outcomes in a prospectively registered protocol. The primary outcomes were pain intensity and acceptability. We measured pain intensity at end-of-treatment on a 0-100 point scale and considered 10 points the minimal clinically important difference. We defined acceptability as the odds of stopping treatment for any reason.

resultsWe included 23 RCTs in this review. Data were available for pain in 17 trials and acceptability in 14 trials. Treatment with antidepressants decreased pain intensity by 4.33  points (95% CI - 6.15 to - 2.50) on a 0-100 scale, compared to placebo. Treatment with antidepressants increased the odds of stopping treatment for any reason (OR 1.27 [95% CI 1.03 to 1.56]), compared to placebo.

conclusionsTreatment of LBP with antidepressants is associated with small reductions in pain intensity and increased odds of stopping treatment for any reason, compared to placebo. The effect on pain is not clinically important. The effect on acceptability warrants consideration. These findings provide Level I evidence to guide clinicians in their use of antidepressants to treat LBP.

trial registrationWe prospectively registered the protocol for this systematic review on PROSPERO ( CRD42020149275 ).

Indexed as

Low Back PainAdultAntidepressive AgentsHumansAntidepressive AgentsAnalgesicsAntidepressantsDrug therapyLow back painMeta-analysisReview

Identifiers

PMID33627178
PMCPMC7905649
OpenAlexW3130096594

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.