Psychosomatic Medicine, Vol 60, Issue 4 503-509, Copyright © 1998 by American Psychosomatic Society

ORIGINAL ARTICLES

Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis

DA Fishbain, RB Cutler, HL Rosomoff and RS Rosomoff
Department of Psychiatry, University of Miami School of Medicine, University of Miami Comprehensive Pain & Rehabilitation Center, at South Shore Hospital, South Miami Beach, Florida 33319, USA. cprc@umcprc.com

OBJECTIVE: A significant amount of evidence indicates that some antidepressants have an analgesic effect. We wished to determine whether this analgesic effect could be demonstrated in studies that had used antidepressants for the treatment of pain in patients diagnosed with psychogenic pain or somatoform pain disorder. Meta-analysis was used for this purpose. METHODS: All randomized, placebo-controlled antidepressant treatment studies of patients diagnosed with psychogenic pain disorder or somatoform pain disorder were isolated. These studies were reviewed and relevant statistics were coded. For each study, a single p value for the drug/placebo comparison was found or calculated for pain change scores from pretreatment to completion of treatment. The z scores and effect sizes were calculated for each study, followed by a calculation of an overall z score and effect size. RESULTS: Eleven studies fulfilled the inclusion and exclusion criteria for this meta-analysis. The combined difference showed that antidepressants decreased pain intensity in patients with psychogenic pain or somatoform pain disorder significantly more than placebo (z = 5.71, p<.0001). The overall effect size was large (mean = 0.48) and ranged from 0 to 0.91. CONCLUSIONS: The results indicate that, in patients diagnosed with psychogenic pain or somatoform pain disorder, antidepressant treatment resulted in a reduction in pain that was significantly greater than that of placebo. Possible explanations for these results are discussed.

This article has been cited by other articles:

				M. Ikawa and K. Yamada Mental disorders diagnosed in half of outpatients in orofacial pain clinic. Psychosomatics, March 1, 2006; 47(2): 179 - 180. [Full Text] [PDF]

				R. RUDDY and A. HOUSE Meta-review of high-quality systematic reviews of interventions in key areas of liaison psychiatry The British Journal of Psychiatry, August 1, 2005; 187(2): 109 - 120. [Abstract] [Full Text] [PDF]

				T. Muller, M. Mannel, H. Murck, and V. W. Rahlfs Treatment of Somatoform Disorders With St. John's Wort: A Randomized, Double-Blind and Placebo-Controlled Trial Psychosom Med, July 1, 2004; 66(4): 538 - 547. [Abstract] [Full Text] [PDF]

				F. J. Keefe, M. A. Lumley, A. L. H. Buffington, J. W. Carson, J. L. Studts, C. L. Edwards, D. J. Macklem, A. K. Aspnes, L. Fox, and D. Steffey Changing Face of Pain: Evolution of Pain Research in Psychosomatic Medicine Psychosom Med, November 1, 2002; 64(6): 921 - 938. [Abstract] [Full Text] [PDF]

				J. V. Campo and G. Fritz A Management Model for Pediatric Somatization Psychosomatics, December 1, 2001; 42(6): 467 - 476. [Abstract] [Full Text] [PDF]

				S. Wessely Review: antidepressants reduce pain intensity in psychogenic pain or somatoform pain disorder Evid. Based Ment. Health, February 1, 1999; 2(1): 13 - 13. [Full Text]