I read with great interest the article by Wolfe and Michaud recently published in Arthritis Care & Research (1). The authors have clearly illustrated the value and need for assessing pain and depression in the treatment of rheumatoid arthritis. Not surprisingly, one aspect of arthritis pain management that is often overlooked is the clinical use of the analgesic effects of antidepressants (2).
For instance, the recent Stepped Care for Affective Disorders and Musculoskeletal Pain study has reported moderate attenuation of arthritis pain following the clinical use of antidepressants, especially in patients with low back pain (3). A similar marked decrease in the Western Ontario and McMaster Universities Osteoarthritis Index was noted after as little as 3 weeks of therapeutic use of the antidepressants such as duloxetine in patients with osteoarthritis of the knee (4). Another recent addition to this list of highly effective antidepressants is milnacipran. Patients with fibromyalgia demonstrated sustained pain relief following therapy with milnacipran (5).
The above examples clearly illustrate the effectiveness of antidepressants in the treatment of arthritis pain. There is a clear and urgent need for more studies to further elaborate the usefulness of antidepressants in other rheumatic disorders such as rheumatoid arthritis.