Anti-Depressants Bad For Pain, Make Case For Medical Marijuana

The conclusion of a recent study in the Cochrane Review, as noted today by the New York Times's Well blog, is that anti-depressants aren't particularly useful for treating back pain.

"Most of the studies found that patients receiving antidepressants didn’t experience any more pain relief than those taking a placebo, although some of the research suggested a benefit. Overall, the analysis concluded that there’s no evidence that prescribing antidepressants to treat back pain relieves pain or improves function. The researchers also found that in patients with low back pain, antidepressant treatment didn’t curb depression, either."

This ties in nicely with a recent paper pooh-poohing Eli Lilly's claims that Cymbalta works to ease chronic pain, as I noted in December.

It's not clear to me how much of the approximately $20 billion a year in anti-depressant sales is driven by prescriptions for treating pain, but I know it's a hefty amount. A friend of mine in antoehr state who suffers from degenerative disk disease was forced off his opiate prescriptions by his pain management clinic a ways back due to an agreement his doc had with the DEA. He was forced onto Cymbalta and Lyrica, which did nothign to alleviate his pain and screwed up his liver. He's off those drugs now and back on the opiates, but they don't seem to be working as well this time out, possibly due to effects Cymbalta had on his liver.

In the sickest irony of all, he recently went to a counselor on his pain management team and spoke to her about medical marijuana. He lives in a state without a medical marijuana law. His counselor told him that if he ever broached the subject with her or the doctor again that they would force him to undergo random, mandatory urinalysis or he'd lose his prescription for opiates. Nice bit of coercion there--and I thought it was unethical for medical professionals to coerce patients.

BTW, his doctor's pain management clinic has approximately 600 patients and he tells me that about 75 percent of the patients have been put on Cymbalta or similar anti-depressants in the last year or so. Nice little target market for Big Pharma.

I think this shift to using anti-depressants has been driven by the DEA's push to limit the use of opiates in treating chronic pain, principally because the feds hate any drug that gets people high (unless it's an anti-depressant) and because some opiates have been getting diverted into the black market. I understand the feds' concerns, but I think the DEA's policies--as well as those of some states such as Washington--have been a true disaster for people with chronic pain.

I genuinely believe that what we are seeing here is yet another argument for the use of medical marijuana in treating chronic pain. Why? Because it works for a number of patients and because it doesn't turn people into pill junkies or kill them with overdoses of opiates, not does it carry all the problems that anti-depressants do. I simply think it's time for the feds to take a chill pill--may I suggest Paxil?--and support adequate research of medical marijuana for treating chronic pain, and perhaps reschedule marijuana. After all, citizens and legislatures in 13 states have decided that pot is medicine. Surely, they cannot all be wrong.

But I'm sure the feds will continue to persecute medical marijuana patients in California and elsewhere (it's hard for the DEA to justify its existence otherwise), and that this situation will not change under the next President. I've heard that Obama has made noises about decriminalizing pot. That's nice, but I'll believe it when I see it.

To those of you who will object and say that pot causes psychosis and other untoward reactions in a small percentage of people who smoke pot, I'd simply point out to you that anti-depressants are well known to cause the same exact problems in some people.