Do antidepressants help people with low back pain?
Vanessa Jordan
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1
Ferraro MC, Urquhart DM, Ferreira GE, Wewege MA, Abdel Shaheed C, Traeger AC, Hoving JL, Visser EJ, McAuley JH, Cashin AG. Antidepressants for low back pain and spine-related leg pain. Cochrane Database of Systematic Reviews 2025, Issue 3. Art. No. CD001703. doi:10.1002/14651858.CD001703.pub4.1
Background
Low back pain is a significant global health issue, with a 1-month prevalence of 23% with a peak prevalence noted at 85 years of age.2 It has been the leading cause of years lived with disability for the past 30 years and is projected to affect close to 850 million people by 2050. The condition places a heavy burden on individuals and society, and results in substantial healthcare costs.3,4
Clinical bottom line
This Cochrane review suggests that serotonin and norepinephrine reuptake inhibitors (SNRIs) can slightly improve non-specific low back pain comparative to placebo. Conversely, this systematic review was unable to show that selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) had any effect1 (see Table 1).
| Intervention | Outcome measured | Success | Evidence | Caveat | |
|---|---|---|---|---|---|
| Serotonin and norepinephrine reuptake inhibitors (SNRIs) | Pain | SNRIs resulted in a significant small improvement in pain. | This evidence is of moderate quality and is based on 1415 participants from 4 studies. | No difference was shown for severe adverse events, but SNRIs were more likely to cause an increase in total adverse events. | |
| Disability | SNRIs resulted in a significant small improvement in disability. | This evidence is of moderate quality and is based on 1348 participants from 4 studies. | |||
| Selective serotonin reuptake inhibitors (SSRIs) | Pain | SSRIs did not result in any significant improvement in pain. | This evidence is of low quality and is based on 199 participants from 3 studies. | None of the studies recorded serious adverse events and there was no evidence that SSRIs resulted in any increase in the overall number of adverse events, but very few studies recorded these outcomes. | |
| Disability | SSRIs did not result in any significant improvement in disability. | This evidence is of low quality and is based on 92 participants from 1 study. | |||
| Tricyclic antidepressants (TCAs) | Pain | TCAs did not result in any significant improvement in pain. | This evidence is of moderate quality and is based on 417 participants from 4 studies. | No difference was shown for severe adverse events or for total adverse events, but very few studies recorded these outcomes. | |
| Disability | TCAs resulted in a significant small improvement in disability. | This evidence is of moderate quality and is based on 330 participants from 3 studies. |
Compared to placebo, both SNRIs and TCAs slightly improved disability. But SSRIs were not shown to improve disability1 (see Table 1). Disability was measured on a low back-specific disability scale or questionnaire.
References
1 Ferraro MC, Urquhart DM, Ferreira GE, et al. Antidepressants for low back pain and spine‐related leg pain. Cochrane Database Syst Rev [3] 2025; CD001703.
| Crossref | Google Scholar |
2 GBD 2021 Low Back Pain Collaborators.. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023; 5(6): E316-E329.
| Crossref | Google Scholar | PubMed |
3 Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008; 8(1): 8-20.
| Crossref | Google Scholar | PubMed |
4 Hallberg S, Rolfson O, Karppinen J, et al. Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study. Scand J Pain 2023; 23(1): 126-138.
| Crossref | Google Scholar | PubMed |
