Chronic pain is relatively common among older adults, often associated with long-term conditions like arthritis.
University of Sydney research has found people over 65 are being prescribed antidepressants as pain treatment based on international guidelines that use limited evidence. In fact, researchers found that in the last 40 years there have been only 15 trials involving about 1400 participants globally focusing on the benefit of antidepressants for pain in older people.
The study fills a much-needed gap in research by bringing together the information from these trials to look at the efficacy and harms of antidepressants for acute and chronic non-cancer pain in those over 65-years old.
Lead author Dr Sujita Narayan, a Research Fellow at the University’s Institute for Musculoskeletal Health said international guidelines recommending antidepressants for chronic pain are heavily based on studies that either exclude older adults or include only a small number of them.
“We shouldn’t rely on findings from studies with younger people and apply them to older adults because they are different – older people’s bodies undergo changes that alter how they respond to medications. This can lead to different effects in older people compared to younger people,” said Dr Narayan.
The study found a lack of evidence to inform the use of antidepressants for most pain conditions in older adults, and urges prescribing and treatment practices that consider the unique needs and risks of older adults.
Researchers highlight the need for more inclusive trials, with older people that represent an exponentially growing proportion of the population.
The study also supports guidelines on the management of chronic non-cancer pain in older people recommending a multidimensional approach using non-pharmacological strategies, such as physical exercise and cognitive behaviour therapy based on trials done specifically in older people.
Further information
Efficacy and safety of antidepressants for pain in older adults – A systematic review and meta-analysis: British Journal of Clinical Pharmacology
