On the putative efficacy of the antidepressants in chronic, benign pain syndromes. An update

Previous reviews of the use of antidepressant medication in the treatment of chronic, benign pain syndromes have reported significant analgesic effects in over 80% of subjects in less time and at lower doses than that required for the antidepressant effect. The authors' prior meta-analytic review did not support this effect, after controlling for trial quality. This article reports on an update of that review. The results are similar to those of the prior review, showing that 70% of trials again failed to meet minimal design and protocol criteria. Of the remainder, none met all four types of validity criteria used as an additional screening for trial quality. Improvement was noted in protocol (but not design) development and in the frequency of trials meeting at least two validity criteria.