The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and blinding), by inconsistency (unexplained variability in results), and by imprecise results (few patients and outcome events).
A Cochrane review included 8 studies with a total of 442 subjects investigating the effects of antidepressants in pain management for patients with rheumatoid arthritis, with or without coexistent depression. All studies evaluated tricyclic antidepressants (TCAs); 7 studies were placebo controlled and 2 studies included an SSRI as a comparator. Four studies (n=334) evaluated amitriptyline, 2 studies (n=52) dothiepin, 1 study trimipramine (n = 20), and one study imipramine (n = 36).
Meta-analyses for pain outcomes were not conducted. The qualitative analyses found no evidence of an effect of antidepressants on pain intensity or depression in the short-term (less than one week), and conflicting evidence of a medium- (one to six weeks) or long-term (more than six weeks) benefit. There were significantly more minor adverse events in patients receiving TCAs compared with those receiving a placebo (RR 2.27, 95% CI 1.17 to 4.42), but there was no significant increase in withdrawals due to an adverse event (RR 1.09, 95% CI 0.49 to 2.42).
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