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These processes contribute to persistent musculoskeletal pain, difficulties with sleep, feelings of depression, and ongoing fatigue. Serotonin and norepinephrine are key mediators of pain control, and evidence indicates that dual reuptake inhibition provides superior analgesia compared to single-pathway approaches. Accordingly, serotonin\u2013norepinephrine reuptake inhibitors (SNRIs), including milnacipran and duloxetine, approved for FM treatment, show favorable efficacy and tolerability compared with tricyclic antidepressants. This integrative literature review aimed to evaluate the impact of SNRIs on musculoskeletal pain, fatigue, depression, and quality of life in patients with FM by analyzing randomized clinical trials (RCTs), identified via PubMed\/MEDLINE searches (2015\u20132025) in English\/Portuguese using descriptors: \u201cFibromyalgia\u201d, \u201cSerotonin and Norepinephrine Reuptake Inhibitors\u201d, \u201cDuloxetine\u201d and \u201cMilnacipran\u201d. From 195 records screened, 18 studies met inclusion criteria (9.2% inclusion rate); duloxetine evaluated in 16 studies (88.9%), milnacipran in 2 (11.1%); SNRIs demonstrated superior efficacy vs. placebo: pain reduction 30\u201340%, fatigue improvement 25%, quality of life enhancement 20%. SNRIs were overall more effective than placebo but did not achieve high levels of analgesia, underscoring the need for further research on long-term efficacy and comparisons with combination pharmacological and non-pharmacological therapies. SNRIs significantly alleviate musculoskeletal pain (30\u201350% of patients), fatigue, depression symptoms, and improve quality of life in FM versus placebo. Duloxetine showed superior efficacy for pain\/depression; milnacipran excelled in sleep quality. Long-term studies and combination therapies warrant further investigation.<\/jats:p>","DOI":"10.3390\/clinpract16040068","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:41:53Z","timestamp":1774878113000},"page":"68","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Serotonin\u2013Norepinephrine Reuptake Inhibitors in Fibromyalgia Management: An Integrative Literature Review of Clinical Evidence"],"prefix":"10.3390","volume":"16","author":[{"given":"Isabella Oliveira do","family":"Lago","sequence":"first","affiliation":[{"name":"Bauru School of Medicine, University of Sao Paulo (FMBRU\/USP), Bauru 17012-901, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruna Moura Medina","family":"Diniz","sequence":"additional","affiliation":[{"name":"Ribeir\u00e3o Preto School of Medicine, University of Sao Paulo (FMRP\/USP), Ribeir\u00e3o Preto 14049-900, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9914-1262","authenticated-orcid":false,"given":"Daniela Vieira","family":"Buchaim","sequence":"additional","affiliation":[{"name":"Medical School, University Center of Adamantina (FAI), Adamantina 17800-000, Brazil"},{"name":"Center for the Study of Venoms and Venomous Animals (CEVAP), Sao Paulo State University (UNESP), Botucatu 18610-307, Brazil"},{"name":"Postgraduate Department, Dentistry School, Faculty of the Midwest Paulista (FACOP), Piratininga 17499-010, Brazil"},{"name":"Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ\/USP), Sao Paulo 05508-270, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5881-2218","authenticated-orcid":false,"given":"Rogerio Leone","family":"Buchaim","sequence":"additional","affiliation":[{"name":"Center for the Study of Venoms and Venomous Animals (CEVAP), Sao Paulo State University (UNESP), Botucatu 18610-307, Brazil"},{"name":"Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ\/USP), Sao Paulo 05508-270, Brazil"},{"name":"Department of Biological Sciences, Bauru School of Dentistry (FOB\/USP), University of Sao Paulo, Bauru 17012-901, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"680","DOI":"10.7556\/jaoa.2013.034","article-title":"Fibromyalgia: A Clinical Update","volume":"113","author":"Hawkins","year":"2013","journal-title":"J. Osteopath. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"186","DOI":"10.55563\/clinexprheumatol\/i19pig","article-title":"Fibromyalgia Position Paper","volume":"39","author":"Giorgi","year":"2021","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Paredes, S., Cantillo, S., Candido, K.D., and Knezevic, N.N. (2019). An Association of Serotonin with Pain Disorders and Its Modulation by Estrogens. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20225729"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"422","DOI":"10.55563\/clinexprheumatol\/0c7d6v","article-title":"Fibromyalgia in Women: Somatisation or Stress-Evoked, Sex-Dimorphic Neuropathic Pain?","volume":"39","year":"2021","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bennett, R.M., Jones, J., Turk, D.C., Russell, I.J., and Matallana, L. (2007). An Internet Survey of 2596 People with Fibromyalgia. BMC Musculoskelet. Disord., 8.","DOI":"10.1186\/1471-2474-8-27"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/acr.20140","article-title":"The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity","volume":"62","author":"Wolfe","year":"2010","journal-title":"Arthritis Care Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5497\/wjp.v6.i1.1","article-title":"Emerging Pharmacological Strategies for the Treatment of Fibromyalgia","volume":"6","author":"Lawson","year":"2017","journal-title":"World J. Pharmacol."},{"key":"ref_8","first-page":"3","article-title":"One Year in Review 2020: Fibromyalgia","volume":"38","author":"Bazzichi","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_9","first-page":"255","article-title":"The Current Treatment of Fibromyalgia","volume":"1","year":"2018","journal-title":"Braz. J. Pain"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Maffei, M.E. (2020). Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21217877"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e13477","DOI":"10.1097\/MD.0000000000013477","article-title":"Potency of Descending Pain Modulatory System Is Linked with Peripheral Sensory Dysfunction in Fibromyalgia","volume":"98","author":"Brietzke","year":"2019","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1016\/j.amjmed.2009.09.008","article-title":"Pathophysiology of Fibromyalgia","volume":"122","author":"Bradley","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Teleanu, R.I., Niculescu, A.-G., Roza, E., Vlad\u00e2cenco, O., Grumezescu, A.M., and Teleanu, D.M. (2022). Neurotransmitters\u2014Key Factors in Neurological and Neurodegenerative Disorders of the Central Nervous System. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23115954"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s13063-015-0659-4","article-title":"Fibromyalgia, Milnacipran and Experimental Pain Modulation: Study Protocol for a Double Blind Randomized Controlled Trial","volume":"16","author":"Macian","year":"2015","journal-title":"Trials"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1016\/j.amjmed.2009.09.010","article-title":"Further Strategies for Treating Fibromyalgia: The Role of Serotonin and Norepinephrine Reuptake Inhibitors","volume":"122","author":"Mease","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1016\/j.jpain.2014.09.011","article-title":"Segregating the Cerebral Mechanisms of Antidepressants and Placebo in Fibromyalgia","volume":"15","author":"Jensen","year":"2014","journal-title":"J. Pain"},{"key":"ref_17","first-page":"37","article-title":"Serotonin Norepinephrine Reuptake Inhibitors:A Pharmacological Comparison","volume":"11","author":"Sansone","year":"2014","journal-title":"Innov. Clin. Neurosci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1016\/S1734-1140(13)71522-6","article-title":"Neuronal and Immunological Basis of Action of Antidepressants in Chronic Pain\u2014Clinical and Experimental Studies","volume":"65","author":"Mika","year":"2013","journal-title":"Pharmacol. Reports"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1136\/annrheumdis-2016-209724","article-title":"EULAR Revised Recommendations for the Management of Fibromyalgia","volume":"76","author":"Macfarlane","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_20","first-page":"CD010292","article-title":"Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia","volume":"2","author":"Welsch","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_21","first-page":"105","article-title":"Fibromyalgia and the Concept of Resilience","volume":"37","author":"Casale","year":"2019","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1185\/03007995.2013.784191","article-title":"Comparison of Safety Outcomes among Caucasian, Hispanic, Black, and Asian Patients in Duloxetine Studies of Chronic Painful Conditions","volume":"29","author":"Gaynor","year":"2013","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.nicl.2014.09.007","article-title":"Resting State Connectivity Correlates with Drug and Placebo Response in Fibromyalgia Patients","volume":"6","author":"Ichesco","year":"2014","journal-title":"NeuroImage Clin."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/j.1532-2149.2013.00341.x","article-title":"Duloxetine Use in Chronic Painful Conditions\u2014Individual Patient Data Responder Analysis","volume":"18","author":"Moore","year":"2014","journal-title":"Eur. J. Pain"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lipkovich, I.A., Choy, E.H., Van Wambeke, P., Deberdt, W., and Sagman, D. (2014). Typology of Patients with Fibromyalgia: Cluster Analysis of Duloxetine Study Patients. BMC Musculoskelet. Disord., 15.","DOI":"10.1186\/1471-2474-15-450"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1186\/s13075-014-0451-y","article-title":"Cost-Utility of Cognitive Behavioral Therapy versus U.S. Food and Drug Administration Recommended Drugs and Usual Care in the Treatment of Patients with Fibromyalgia: An Economic Evaluation alongside a 6-Month Randomized Controlled Trial","volume":"16","author":"Luciano","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.pain.2013.12.029","article-title":"Effectiveness of Group Acceptance and Commitment Therapy for Fibromyalgia: A 6-Month Randomized Controlled Trial (EFFIGACT Study)","volume":"155","author":"Luciano","year":"2014","journal-title":"Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.3899\/jrheum.141196","article-title":"Efficacy and Safety of Pregabalin in Patients with Fibromyalgia and Comorbid Depression Taking Concurrent Antidepressant Medication: A Randomized, Placebo-Controlled Study","volume":"42","author":"Arnold","year":"2015","journal-title":"J. Rheumatol."},{"key":"ref_29","first-page":"S82","article-title":"A Randomised Controlled Trial Comparing Duloxetine and Acetyl L-Carnitine in Fibromyalgic Patients: Preliminary Data","volume":"33","author":"Leombruni","year":"2015","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s13075-015-0718-y","article-title":"A Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Duloxetine in Japanese Fibromyalgia Patients","volume":"17","author":"Murakami","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1097\/j.pain.0000000000000558","article-title":"Combination of Pregabalin with Duloxetine for Fibromyalgia: A Randomized Controlled Trial","volume":"157","author":"Gilron","year":"2016","journal-title":"Pain"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/papr.12409","article-title":"Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study","volume":"17","author":"Ramzy","year":"2017","journal-title":"Pain Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1080\/14397595.2016.1245237","article-title":"An Open-Label, Long-Term, Phase III Extension Trial of Duloxetine in Japanese Patients with Fibromyalgia","volume":"27","author":"Murakami","year":"2017","journal-title":"Mod. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s10067-021-05890-6","article-title":"No Effect of Approved Fibromyalgia Drugs on the Social Pain (Invalidation) Contrary to Physical Pain: An Open-Label Short-Term Randomized Clinical Trial","volume":"41","author":"Bidari","year":"2022","journal-title":"Clin. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1515\/jcim-2020-0116","article-title":"Okada Purifying Therapy in Combination with Duloxetine vs. Duloxetine Alone in Patients with TMD and Fibromyalgia: A Randomized Clinical Study","volume":"18","author":"Bruti","year":"2021","journal-title":"J. Complement. Integr. Med."},{"key":"ref_36","first-page":"1323","article-title":"Palmitoylethanolamide and Acetyl-L-Carnitine Act Synergistically with Duloxetine and Pregabalin in Fibromyalgia: Results of a Randomised Controlled Study","volume":"41","author":"Salaffi","year":"2023","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ablin, J.N., Lang, E., Catalogna, M., Aloush, V., Hadanny, A., Doenyas-Barak, K., Finci, S., Polak, N., Fishlev, G., and Korin, C. (2023). Hyperbaric Oxygen Therapy Compared to Pharmacological Intervention in Fibromyalgia Patients Following Traumatic Brain Injury: A Randomized, Controlled Trial. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0282406"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s40199-019-00257-4","article-title":"Comparing Duloxetine and Pregabalin for Treatment of Pain and Depression in Women with Fibromyalgia: An Open-Label Randomized Clinical Trial","volume":"27","author":"Bidari","year":"2019","journal-title":"DARU J. Pharm. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12969-019-0325-6","article-title":"Efficacy and Safety of Duloxetine versus Placebo in Adolescents with Juvenile Fibromyalgia: Results from a Randomized Controlled Trial","volume":"17","author":"Upadhyaya","year":"2019","journal-title":"Pediatr. Rheumatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.reuma.2020.02.003","article-title":"Fisiopatolog\u00eda de La Fibromialgia","volume":"16","year":"2020","journal-title":"Reumatol. Cl\u00edn."},{"key":"ref_41","first-page":"1065","article-title":"Fibromyalgia: One Year in Review 2022","volume":"40","author":"Giorgi","year":"2022","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Alzabibi, M.A., Shibani, M., Alsuliman, T., Ismail, H., Alasaad, S., Torbey, A., Altorkmani, A., Sawaf, B., Ayoub, R., and Khalayli, N. (2022). Fibromyalgia: Epidemiology and Risk Factors, a Population-Based Case-Control Study in Damascus, Syria. BMC Rheumatol., 6.","DOI":"10.1186\/s41927-022-00294-8"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Siracusa, R., Di Paola, R., Cuzzocrea, S., and Impellizzeri, D. (2021). Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22083891"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"376","DOI":"10.20344\/amp.10433","article-title":"An\u00e1lise Da Revis\u00e3o Cochrane: Pregabalina No Tratamento Da Dor Cr\u00f3nica Moderada a Grave Em Adultos Com Fibromialgia. Cochrane Database Syst Rev. 2016; 9: CD011790 e 2016; 4: CD009002","volume":"31","author":"Sousa","year":"2018","journal-title":"Acta Med. Portuguesa"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"537","DOI":"10.2147\/JPR.S281483","article-title":"Efficacy and Safety of Pregabalin for Fibromyalgia in a Population of Chinese Subjects","volume":"14","author":"Zhang","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"JCNSD.S4127","DOI":"10.4137\/JCNSD.S4127","article-title":"Duloxetine: A Review of Its Safety and Efficacy in the Management of Fibromyalgia Syndrome","volume":"2","author":"Smith","year":"2010","journal-title":"J. Cent. Nerv. Syst. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1038\/nrrheum.2013.177","article-title":"Juvenile Fibromyalgia: Current Status of Research and Future Developments","volume":"10","author":"Ting","year":"2014","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jpain.2010.01.002","article-title":"Comparative Efficacy and Harms of Duloxetine, Milnacipran, and Pregabalin in Fibromyalgia Syndrome","volume":"11","author":"Petzke","year":"2010","journal-title":"J. Pain"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"E2212939","DOI":"10.1001\/jamanetworkopen.2022.12939","article-title":"Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-Analysis","volume":"5","author":"Farag","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_50","first-page":"CD011790","article-title":"Pregabalin for Pain in Fibromyalgia in Adults","volume":"2016","author":"Derry","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1002\/art.24000","article-title":"A Systematic Review on the Effectiveness of Treatment with Antidepressants in Fibromyalgia Syndrome","volume":"59","author":"Sommer","year":"2008","journal-title":"Arthritis Care Res."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Sultan, A., Gaskell, H., Derry, S., and Andrew, R.A. (2008). Duloxetine for Painful Diabetic Neuropathy and Fibromyalgia Pain: Systematic Review of Randomised Trials. BMC Neurol., 8.","DOI":"10.1186\/1471-2377-8-29"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Rodrigues-Amorim, D., Olivares, J.M., Spuch, C., and Rivera-Baltan\u00e1s, T. (2020). A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.554899"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1097\/BRS.0000000000001707","article-title":"Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Duloxetine Monotherapy in Japanese Patients With Chronic Low Back Pain","volume":"41","author":"Konno","year":"2016","journal-title":"Spine"},{"key":"ref_55","first-page":"CD011789","article-title":"Milnacipran for Neuropathic Pain in Adults","volume":"2015","author":"Derry","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_56","first-page":"CD008244","article-title":"Milnacipran for Neuropathic Pain and Fibromyalgia in Adults","volume":"3","author":"Derry","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_57","first-page":"CD008244","article-title":"Milnacipran for Pain in Fibromyalgia in Adults","volume":"2015","author":"Cording","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.neuroimage.2005.04.034","article-title":"Mining the Posterior Cingulate: Segregation between Memory and Pain Components","volume":"27","author":"Nielsen","year":"2005","journal-title":"Neuroimage"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12969-015-0025-9","article-title":"Preliminary Experience Using Milnacipran in Patients with Juvenile Fibromyalgia: Lessons from a Clinical Trial Program","volume":"13","author":"Arnold","year":"2015","journal-title":"Pediatr. Rheumatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s00482-012-1168-y","article-title":"Definition, Diagnostik Und Therapie von Chronischen Schmerzen in Mehreren K\u00f6rperregionen Und Des Sogenannten Fibromyalgiesyndroms Bei Kindern Und Jugendlichen","volume":"26","author":"Zernikow","year":"2012","journal-title":"Der Schmerz"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1007\/s40122-025-00771-1","article-title":"Calcium Channel \u03b12\u03b4 Ligands Mirogabalin, Pregabalin, and Gabapentin: Advancements in Diabetic Peripheral Neuropathic Pain Therapeutics","volume":"14","author":"Wu","year":"2025","journal-title":"Pain Ther."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"24","DOI":"10.64719\/pb.4519","article-title":"Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) for Treatment of Fibromyalgia: A Comprehensive Clinical Review","volume":"55","author":"Malik","year":"2025","journal-title":"Psychopharmacol. Bull."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1176\/appi.psy.45.1.17","article-title":"Effects of duloxetine on painful physical symptoms associated with depression","volume":"45","author":"Goldstein","year":"2004","journal-title":"Psychosomatics"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"106547","DOI":"10.1016\/j.phrs.2022.106547","article-title":"Tantali Fibromyalgic Supplicium: Is There Any Relief with the Antidepressant Employment? A Systematic Review","volume":"186","author":"Ilari","year":"2022","journal-title":"Pharmacol. Res."},{"key":"ref_65","first-page":"CD007115","article-title":"Duloxetine for Treating Painful Neuropathy, Chronic Pain or Fibromyalgia","volume":"2014","author":"Lunn","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2974","DOI":"10.1002\/art.20485","article-title":"A Double-blind, Multicenter Trial Comparing Duloxetine with Placebo in the Treatment of Fibromyalgia Patients with or without Major Depressive Disorder","volume":"50","author":"Arnold","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.pain.2005.06.031","article-title":"A Randomized, Double-Blind, Placebo-Controlled Trial of Duloxetine in the Treatment of Women with Fibromyalgia with or without Major Depressive Disorder","volume":"119","author":"Arnold","year":"2005","journal-title":"Pain"},{"key":"ref_68","first-page":"CD006533","article-title":"Duloxetine versus Other Anti-Depressive Agents for Depression","volume":"10","author":"Nose","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Koechlin, H., Kharko, A., Probst, T., Pradela, J., Buechi, S., and Locher, C. (2021). Placebo Responses and Their Clinical Implications in Fibromyalgia: A Meta-Analysis Using SSRI and SNRI Trials. Front. Pain Res., 2.","DOI":"10.3389\/fpain.2021.750523"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1111\/1756-185X.13953","article-title":"Efficacy of Pregabalin as a Monotherapy versus Combined Pregabalin and Milnacipran in the Management of Fibromyalgia","volume":"23","author":"Elnemr","year":"2020","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_71","first-page":"297","article-title":"Combination Pharmacotherapy for the Treatment of Fibromyalgia","volume":"20","author":"Thorpe","year":"2013","journal-title":"Cochrane Database Syst. Rev."}],"updated-by":[{"DOI":"10.3390\/clinpract16050084","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000}}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/4\/68\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:34:59Z","timestamp":1777458899000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/4\/68"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,28]]},"references-count":71,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["clinpract16040068"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16040068","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,28]]}}}