There was insufficient data for a number needed to treat for an additional beneficial outcome (NNTB) to be calculated for the primary outcome measure of pain. AU - Khalil, Hanan. Firstly, despite extraordinary advances in the understanding of pain mechanisms at the molecular level, there remains a lack of understanding about what actually causes joint pain. Insomnia Severity Index, Medical Outcomes Study (MOS) Sleep Scale, Pittsburgh Sleep Diary (PSD), and Pittsburgh Sleep Quality Index (PSQI)). In Two trials reported withdrawals due to inadequate analgesia. This class of antidepressants increase monoamine levels in many regions of the central nervous system, however their use may be limited by side effects of orthostatic hypotension, dizziness, reflex tachycardia, weight gain and sedation. The presence of pain conditions in addition to the one being studied, may interfere with the ability of patients (or outcome assessors) to evaluate the effects of treatment specifically on the target pain condition. We believe that we identified all relevant studies. Currently there is conflicting scientific evidence to guide physicians, which leads to variations in practice. Antidepressants are known to cross the blood‐brain‐barrier and exert central mechanisms of action that involve both spinal and supraspinal mechanisms (Antidepressants are sometimes used as adjuvant agents to enhance pain relief, help with sleep and reduce depression. Available MAOIs include phenelzine, isocarboxazid, tranylcypromine, selegiline, moclobemide and befloxaton. All studies identified in recent reviews were also identified in our search. If the number of patients analysed were not presented for each time‐point, we used the number of randomised patients in each group at baseline. Potential patient characteristics (e.g. Comparison 6 Tricyclic antidepressant versus placebo ‐ functional status, Outcome 1 HAQ 4 weeks. They also had varying disease severity and pain duration. In addition to the absolute and relative magnitude of effect provided in the summary of findings table, for dichotomous outcomes, we calculated the number needed to treat for an additional beneficial outcome (NNTB) or the number needed to treat for an additional harmful outcome (NNTH) from the control group event rate and the RR using the Visual Rx NNT calculator (From a computer assisted literature search we found 355 articles (CENTRAL 33, MEDLINE 169, EMBASE 127 and PsychINFO 26).

This review shows that in people with RA: We are uncertain whether antidepressants affect pain or functional status because of the very low quality of the evidence. The nature of the target pain condition should also be prespecified, and coexisting pain conditions identified. No haematological events were seen, however there was a case report of agranulocytosis in a study that did not meet the inclusion criteria (The study populations in the included trials of this review are not reflective of current day patients with RA. Where carry‐over effects were thought to exist, and where sufficient data were present, we planned to include in the analysis data from the first period only (In cases where individuals were missing from the reported results, we assumed that the missing value had a poor outcome. Joint pain in RA may be influenced also by disease activity which can fluctuate over time. Abstract. We are uncertain whether antidepressants affect pain or functional status because of the very low quality of the evidence. The percentage of patients with and without depression, and the severity of their depression varied amongst the trials. Given the paucity of trials with a low risk of bias, representative homogenous populations, adequate follow‐up and large sample sizes, further research is required. There is currently insufficient evidence to support the routine prescription of antidepressants as analgesics in patients with RA as no reliable conclusions about their efficacy can be drawn from eight placebo RCTs.

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