A Meta-Analysis of the Effect of Selective Serotonin Reuptake Inhibitors on Pain in Fibromyalgia
Abstract
Abstract
Background
Fibromyalgia is a clinical condition that causes widespread severe pain, sleep problems, fatigue, and often emotional and mental distress. Patients with fibromyalgia may be more sensitive to pain than others.
Aim
The aim of this study is to screen and evaluate the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) in the management of pain in patients with fibromyalgia.
Methods
This systematic review and meta-analysis gathered all studies related to selective serotonin inhibitors in the treatment of pain in fibromyalgia, using the databases of PubMed, the Cochrane Library and Google Scholar. All articles using a visual analogue scale (VAS) were included in the review. All duplicates and non-eligible or unavailable full-text studies were excluded. The primary outcome was defined as pain reduction by VAS score. Secondary outcomes were the assessment of the occurrence of adverse effects at any time in the study or premature withdrawal.
Results
The five studies included in the meta-analysis for pain management have moderate heterogeneity. This is shown by the test of heterogeneity with a p-value greater than 0.05 and an I2 value less than 50%. If the I2 value is more than 50% and the p-value is significant, this results in differing study results. The result of this meta-analysis shows that the SSRI group had a statistically significant reduction in pain (Z = 2.37, p = 0.02).
Conclusion
Based on the results of the meta-analysis, SSRIs may be considered for pain management for a short-term duration, preferably in female patients aged over 45 years old, in the absence of other health problems except for fibromyalgia. However, close monitoring of the potential withdrawal effects is necessary. Despite the significant reduction in pain, it is important to consider other pain management options when SSRIs are prescribed as a monotherapy to fibromyalgia.
Keywords
Serotonin reuptake inhibitors – SSRI – fluoxetine – paroxetine – citalopram – pain – fibromyalgia