Guidelines for the use of antidepressants in painful rheumatic conditions.
OBJECTIVE
Antidepressants are widely used to treat painful chronic rheumatic conditions but, contrary to neuropathic conditions, little is known about their true analgesic properties and value in these situations. Our group, which focuses on pain in rheumatology, aimed to develop recommendations for the use of antidepressants in rheumatology, based on evidence-based review of published data and expert opinion.


METHODS
We identified relevant drugs and conditions and searched Medline, Embase and Pascal (1966-2003) for relevant publications in a number of European languages. We scored each study for quality, and used an expert consensus approach to formulate recommendations.


RESULTS
We identified 77 studies and 12 meta-analyses and literature review on the use of antidepressant to treat painful rheumatological conditions. Forty-nine of these clinical studies were considered valid and were used to develop the recommendations. When evidence was lacking we based recommendations on our clinical experience.


CONCLUSIONS
These recommendations for the treatment of painful rheumatological conditions with antidepressants were developed using evidence-based and expert consensus approaches and are the first of their kind in this field. Our review of the literature highlights the need for further, well-designed clinical studies of the use of antidepressants to treat painful rheumatological conditions.
Cercle d'étude de la douleur en rhumatologie, CEDR, Limoges, France. serge.perrot@cch.ap-hop-paris.fr
Serge
S
Perrot
Emmanuel
E
Maheu
Rose-Marie
RM
Javier
Alain
A
Eschalier
Anne
A
Coutaux
Manuela
M
LeBars
Philippe
P
Bertin
Bernard
B
Bannwarth
Richard
R
Trèves
D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017410:Practice Guidelines as Topic; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*
D000928:Antidepressive Agents