Most antidepressants offer little or no benefit when prescribed off label for chronic pain, with only the use of SNRIs supported by moderate-certainty evidence, according to an Australian-led review.

Overall, SNRIs were shown to be effective for managing seven out of the 22 pain conditions covered — far higher than any other antidepressant class, say University of Sydney researchers.

“Moderate-certainty evidence supported the efficacy of SNRIs — mostly duloxetine at median doses of 60-120mg for back pain, postoperative pain, fibromyalgia and neuropathic pain,” they wrote.

SNRIs also showed some benefit for aromatase inhibitor therapy–induced pain in breast cancer, depression and comorbid chronic pain, and knee osteoarthritis. But the strength of evidence for these conditions was rated “low”.