A Deep Dive into the Latest 2023 Cochrane Review

Not Just for the Blues—How a Mood Treatment Could Help with Back Pain Too

Chronic pain isn’t just a dull ache you push through—it’s a global health crisis. It affects more than one-third of adults around the world, creeping into sleep, limiting movement, draining mental health, and making daily life feel like a constant uphill battle.

But what if we’ve been overlooking an unexpected tool for pain relief?

Surprisingly, certain antidepressants might not just lift your mood—they could actually reduce physical pain. Yep, you read that right.

The Big Study: What Was It All About?

In 2023, a major Cochrane review led by researcher Hollie Birkinshaw shook things up. It pulled together findings from 176 randomized controlled trials, involving nearly 29,000 people dealing with chronic pain conditions like:

• Fibromyalgia – a long-term condition that causes widespread body pain, extreme fatigue, sleep issues, and memory trouble.
• Nerve-related pain (a.k.a. neuropathic pain)
• Musculoskeletal pain (think arthritis or persistent back pain)

The goal? To compare the effectiveness and safety of 25 different antidepressants—and see which, if any, really helped people feel less pain.

Why Antidepressants for Pain?

One particular medication often discussed is duloxetine, a treatment commonly prescribed for depression and anxiety—but also approved in many countries, including Malaysia, for treating nerve-related pain like diabetic neuropathy and fibromyalgia. Duloxetine, available in Malaysia under brand names like Cymbalta, is prescribed by doctors for chronic back or joint pain, nerve-related discomfort, cases where traditional painkillers like NSAIDs or opioids aren’t suitable, or when pain disrupts sleep, focus, or daily functioning—often as part of a broader, personalized care plan rather than a standalone solution.

So why would a mood medication work for physical pain?

The link lies in how pain is processed in the brain. Antidepressants like duloxetine affect chemicals such as serotonin and noradrenaline, which play a role in how we perceive pain—not just how we feel emotionally.

But It’s Not All Sunshine

Most studies were short-term (about 10 weeks), and safety data is still weak. Common side effects like nausea, dizziness, or sleep disturbance were reported—but long-term effects remain uncertain.

Also, people with anxiety or depression were usually excluded from these studies. So while duloxetine might help bone and spine pain, we don’t fully know how it works when mental health challenges are also involved.

Why This Matters in Bone & Spine Care

Patients with chronic back or joint pain often struggle for years, trying multiple therapies with mixed results. Adding duloxetine to a care plan—under proper medical supervision—could be a game-changer, especially when:

• Pain has a nerve-related origin.
• NSAIDs and opioids can cause side effects and carry extra risks—and sometimes, they don’t work as well as duloxetine. That’s because duloxetine works differently by affecting brain chemicals that not only help reduce pain but can also improve mood.
• Pain is impacting sleep, focus, or mood.

It’s not a silver bullet—but for many, it might be that missing puzzle piece in a holistic spine pain solution.

At Sutra Medi-Environ, we believe in treating the whole person, not just the symptom. Whether through minimally invasive procedures, advanced technology, or a carefully curated medication plan, our goal is to help you get back to living—not just surviving.

Have questions about managing back pain holistically? Let’s talk solutions that go beyond the surface.