Douleurs chroniques : une vaste étude remet en cause l’efficacité des antidépresseurs

A côté des antalgiques classiques, les antidépresseurs sont des traitements couramment prescrits dans le traitement de la douleur chronique, qu’il s’agisse de la migraine, des céphalées de tension, ou de la fibromyalgie, par exemple. Mais quel est réellement leur niveau d’efficacité ?

Selon une nouvelle revue Cochrane, dont les résultats viennent d’être publiés, le niveau de preuve concernant l’utilisation des antidépresseurs dans le traitement de la douleur chronique -mais ne portant pas sur les céphalées- serait en réalité faible, à une exception près. Avec 176 essais cliniques analysés et près de 30 000 patients inclus, il s’agit de la plus grande analyse à ce jour, sur ce sujet. La majorité des études étaient contrôlées par placebo et à bras parallèles. Les pathologies les plus fréquemment représentées étaient la fibromyalgie (59 études), les douleurs neuropathiques (49 études) et les douleurs musculo-squelettiques (40 études). 25 antidépresseurs ont été analysés.

Concernant les données d’efficacité, la duloxétine était le seul traitement a montrer de façon certaine une efficacité, même si elle reste modérée. La dose standard est apparue aussi efficace qu'une dose élevée pour la majorité des critères de jugement. Le milnacipran a aussi montré un effet, « bien que la certitude des preuves soit inférieure à celle de la duloxétine », affirment les auteurs, suggérant des études supplémentaires. En revanche, « il n'y avait pas suffisamment de preuves pour tirer des conclusions solides sur l'efficacité et l'innocuité de tout autre antidépresseur pour la douleur chronique », poursuivent les chercheurs - y compris l’amitriptyline, couramment utilisée -.

En outre, ils soulignent le manque de données concernant les effets secondaires de ces traitements, avec « des données probantes de très faible certitude pour tous les résultats de sécurité (événements indésirables, événements indésirables graves et retrait) pour tous les antidépresseurs ».

Article rédigé par Georges Simmonds pour RT Flash

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