{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:25:31Z","timestamp":1791379531160,"version":"4.3.3"},"reference-count":71,"publisher":"MedWorks Media","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychopharmacol Bull"],"abstract":"<jats:p>Fibromyalgia is a complex clinical entity characterized by a broad range of symptoms including chronic widespread musculoskeletal pain, profound fatigue, impaired cognition, and mood disturbances. Current understanding of disease pathogenesis assumes neurotransmitter dysregulation and central pain sensitization play a key role resulting in heightened pain sensitivity. Genetic predisposition as well as alterations in endocrine and immune function have been implicated. Accurate diagnosis requires a comprehensive evaluation, and a personalized treatment approach is needed to address the biopsychosocial components of the disease process. Among pharmacologic treatment options, serotonin norepinephrine reuptake inhibitors (SNRIs) have demonstrated analgesic effects in addition to mood stabilizing properties. Currently, duloxetine and milnacipran are approved by the Food and Drug Administration although other agents in this drug class including venlafaxine and desvenlafaxine have been studied in the management of fibromyalgia. In addition, selective norepinephrine reuptake inhibitors, esreboxetine and reboxetine, as well as tramadol, a weak opioid mu-receptor agonist with SNRI activity have shown potential utility. Although some studies have demonstrated SNRIs to be effective and well tolerated in patients with fibromyalgia, individual response may vary. There remains a continued need for large scale clinical trials to establish the safety and clinical effectiveness of these agents in this patient population. Further information is needed to optimize patient selection and dosing regimens as well as elucidate the clinical factors associated with poor response. Moreover, pharmacologic agents may be combined with lifestyle changes and non-drug-based treatments to address the complex interactions of biological and psychosocial factors that facilitate disease development and persistence of symptoms.<\/jats:p>","DOI":"10.64719\/pb.4519","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:23:34Z","timestamp":1761045814000},"page":"24-40","source":"Crossref","is-referenced-by-count":10,"title":["Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) for Treatment of Fibromyalgia: A Comprehensive Clinical Review"],"prefix":"10.64719","volume":"55","author":[{"given":"Aila","family":"Malik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexa","family":"Ryder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanshika","family":"Balayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Jameson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"AL-Jumah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal","family":"Hasoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54175","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification. J Pain. 2016;17(9):T93\u2013T107. doi: 10.1016\/J.JPAIN.2016.06.002.","DOI":"10.1016\/J.JPAIN.2016.06.002"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"D\u2019Agnelli S, Arendt-Nielsen L, Gerra MC et al. Fibromyalgia: Genetics and epigenetics insights may provide the basis for the development of diagnostic biomarkers. Mol Pain. 2019;15 doi: 10.1177\/1744806918819944.","DOI":"10.1177\/1744806918819944"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Park DJ, Lee SS. New insights into the genetics of fibromyalgia. Korean J Intern Med. 2017;32(6):984\u2013995. doi: 10.3904\/KJIM.2016.207.","DOI":"10.3904\/KJIM.2016.207"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Becker S, Schweinhardt P. Dysfunctional Neurotransmitter Systems in Fibromyalgia, Their Role in Central Stress Circuitry and Pharmacological Actions on These Systems. Pain Res Treat. 2011;2012:741746. doi: 10.1155\/2012\/741746.","DOI":"10.1155\/2012\/741746"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Gyorfi M, Rupp A, Abd-Elsayed A. Fibromyalgia Pathophysiology. Biomedicines. 2022;10(12):3070. doi: 10.3390\/BIOMEDICINES10123070.","DOI":"10.3390\/BIOMEDICINES10123070"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"O\u2019Mahony LF, Srivastava A, Mehta P, Ciurtin C. Is fibromyalgia associated with a unique cytokine profile? A systematic review and meta-analysis. Rheumatology (Oxford). 2021;60(6):2602. doi: 10.1093\/RHEUMATOLOGY\/KEAB146.","DOI":"10.1093\/RHEUMATOLOGY\/KEAB146"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Arout CA, Sofuoglu M, Bastian LA, Rosenheck RA. Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study. J Womens Health. 2018;27(8):1035. doi: 10.1089\/JWH.2017.6622.","DOI":"10.1089\/JWH.2017.6622"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547\u20131555. doi: 10.1001\/JAMA.2014.3266.","DOI":"10.1001\/JAMA.2014.3266"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Ruschak I, Montes\u00f3-Curto P, Rossell\u00f3 L, Aguilar Mart\u00edn C, S\u00e1nchez-Montes\u00f3 L, Toussaint L. Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review. Healthcare. 2023;11(2) doi: 10.3390\/HEALTHCARE11020223.","DOI":"10.3390\/HEALTHCARE11020223"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Yunus MB. The role of gender in fibromyalgia syndrome. Curr Rheumatol Rep. 2001;3(2):128\u2013134. doi: 10.1007\/S11926-001-0008-3.","DOI":"10.1007\/S11926-001-0008-3"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Laurent R. Disorders of skeletal muscle. [Published online January 1]; The Musculoskeletal System: Systems of the Body Series. 2010:109\u2013122. doi: 10.1016\/B978-0-7020-3377-3.00008-1.","DOI":"10.1016\/B978-0-7020-3377-3.00008-1"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"de Sanctis V, Abbasciano V, Soliman AT et al. The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder. Acta Bio Medica: Atenei Parmensis. 2019;90(1):134. doi: 10.23750\/ABM.V90I1.8141.","DOI":"10.23750\/ABM.V90I1.8141"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Clauw DJ. Fibromyalgia and related conditions. Mayo Clin Proc. 2015;90(5):680\u2013692. doi: 10.1016\/J.MAYOCP.2015.03.014.","DOI":"10.1016\/J.MAYOCP.2015.03.014"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J. 2012;27(3):192. doi: 10.5001\/OMJ.2012.44.","DOI":"10.5001\/OMJ.2012.44"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Borchers AT, Gershwin ME. Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol. 2015;49(2):100\u2013151. doi: 10.1007\/S12016-015-8509-4.","DOI":"10.1007\/S12016-015-8509-4"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. 2015;35(7):1115\u20131125. doi: 10.1007\/S00296-014-3208-7.","DOI":"10.1007\/S00296-014-3208-7"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Galvez-S\u00e1nchez CM, Duschek S, Del Paso GAR. Psychological impact of fibromyalgia: current perspectives. Psychol Res Behav Manag. 2019;12:117. doi: 10.2147\/PRBM.S178240.","DOI":"10.2147\/PRBM.S178240"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Yepez D, Grandes XA, Manjunatha RT, Habib S, Sangaraju SL. Fibromyalgia and Depression: A Literature Review of Their Shared Aspects. Cureus. 2022;14(5):e24909. doi: 10.7759\/CUREUS.24909.","DOI":"10.7759\/CUREUS.24909"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Wolfe F, Clauw DJ, Fitzcharles MA et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62(5):600\u2013610. doi: 10.1002\/ACR.20140.","DOI":"10.1002\/ACR.20140"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Sosa-Reina MD, Nunez-Nagy S, Gallego-Izquierdo T, Pecos-Mart\u00edn D, Monserrat J, \u00c1lvarez-Mon M. Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Biomed Res Int. 2017;2017 doi: 10.1155\/2017\/2356346.","DOI":"10.1155\/2017\/2356346"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Rooks DS, Gautam S, Romeling M et al. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Arch Intern Med. 2007;167(20):2192\u20132200. doi: 10.1001\/ARCHINTE.167.20.2192.","DOI":"10.1001\/ARCHINTE.167.20.2192"},{"key":"ref22","unstructured":"Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol. 1994;21(4):714\u2013720."},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Hassett AL, Gevirtz RN. Nonpharmacologic Treatment for Fibromyalgia: Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine. doi: 10.1016\/j.rdc.2009.05.003.","DOI":"10.1016\/j.rdc.2009.05.003"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Hassett AL, Cone JD, Patella SJ, Sigal LH. The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome. [Accessed May 8, 2024]; Arthritis Rheum. 2000 43(11):2493\u2013500.","DOI":"10.1002\/1529-0131(200011)43:11<2493::AID-ANR17>3.0.CO;2-W"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Edwards RR, Bingham CO, Bathon J, Haythornthwaite JA. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 2006;55(2):325\u2013332. doi: 10.1002\/ART.21865.","DOI":"10.1002\/ART.21865"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Cao H, Li X, Han M, Liu J. Acupoint stimulation for fibromyalgia: A systematic review of randomized controlled trials. Evidence-based Complementary and Alternative Medicine. 2013;2013 doi: 10.1155\/2013\/362831.","DOI":"10.1155\/2013\/362831"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Chinn S, Caldwell W, Gritsenko K. Fibromyalgia Pathogenesis and Treatment Options Update. Curr Pain Headache Rep. 2016;20(4):25. doi: 10.1007\/s11916-016-0556-x.","DOI":"10.1007\/s11916-016-0556-x"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Tofferi JK, Jackson JL, O\u2019Malley PG. Treatment of fibromyalgia with cyclobenzaprine: A meta-analysis. Arthritis Care Res (Hoboken). 2004;51(1):9\u201313. doi: 10.1002\/ART.20076.","DOI":"10.1002\/ART.20076"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Lederman S, Arnold LM, Vaughn B, Kelley M, Sullivan GM. Efficacy and Safety of Sublingual Cyclobenzaprine for the Treatment of Fibromyalgia: Results From a Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Care Res (Hoboken). 2023;75(11):2359\u20132368. doi: 10.1002\/ACR.25142\/ABSTRACT.","DOI":"10.1002\/ACR.25142\/ABSTRACT"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Berger AA, Keefe J, Winnick A et al. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia. Best Pract Res Clin Anaesthesiol. 2020;34(3):617\u2013631. doi: 10.1016\/J.BPA.2020.08.010.","DOI":"10.1016\/J.BPA.2020.08.010"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Sagy I, Schleider LBL, Abu-Shakra M, Novack V. Safety and Efficacy of Medical Cannabis in Fibromyalgia. Journal of Clinical Medicine. 2019;8(6):807. doi: 10.3390\/JCM8060807.","DOI":"10.3390\/JCM8060807"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Russell IJ, Holman AJ, Swick TJ, Alvarez-Horine S, Wang YG, Guinta D. Sodium oxybate reduces pain, fatigue, and sleep disturbance and improves functionality in fibromyalgia: Results from a 14-week, randomized, double-blind, placebo-controlled study. Pain. 2011;152(5):1007\u20131017. doi: 10.1016\/J.PAIN.2010.12.022.","DOI":"10.1016\/J.PAIN.2010.12.022"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Patten DK, Schultz BG, Berlau DJ. The Safety and Efficacy of Low-Dose Naltrexone in the Management of Chronic Pain and Inflammation in Multiple Sclerosis, Fibromyalgia, Crohn\u2019s Disease, and Other Chronic Pain Disorders. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2018;38(3):382\u2013389. doi: 10.1002\/PHAR.2086.","DOI":"10.1002\/PHAR.2086"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Kurian R, Raza K, Shanthanna H. A systematic review and meta-analysis of memantine for the prevention or treatment of chronic pain. Eur J Pain. 2019;23(7):1234\u20131250. doi: 10.1002\/EJP.1393.","DOI":"10.1002\/EJP.1393"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Robinson C, Dalal S, Chitneni A et al. A Look at Commonly Utilized Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) in Chronic Pain. Health Psychol Res. 2022;10(2):32309. doi: 10.52965\/001C.32309.","DOI":"10.52965\/001C.32309"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: From monoamines to glutamate. Exp Clin Psychopharmacol. 2015;23(1):1. doi: 10.1037\/A0038550.","DOI":"10.1037\/A0038550"},{"key":"ref37","unstructured":"Sansone RA, Sansone LA. Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison. Innov Clin Neurosci. 2014;11(3\u20134):37\u201342."},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Stahl SM, Grady MM, Moret C, Briley M. SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants. CNS Spectr. 2005;10(9):732\u2013747. doi: 10.1017\/S1092852900019726.","DOI":"10.1017\/S1092852900019726"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Issa MA, Marshall Z, Wasan AD. Psychopharmacology for Pain Medicine. In: Essentials of Pain Medicine. (4th) 2018 doi: 10.1016\/B978-0-323-40196-8.00048-6.","DOI":"10.1016\/B978-0-323-40196-8.00048-6"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Turcotte JE, Debonnel G, De Montigny C, H\u00e9bert C, Blier P. Assessment of the serotonin and norepinephrine reuptake blocking properties of duloxetine in healthy subjects. Neuropsychopharmacology. 2001;24(5):511\u2013521. doi: 10.1016\/S0893-133X(00)00220-7.","DOI":"10.1016\/S0893-133X(00)00220-7"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Brummett C, Clauw DJ. Fibromyalgia and Centralized Pain States. In: Essentials of Pain Medicine. (4th) 2018:213\u2013222.","DOI":"10.1016\/B978-0-323-40196-8.00026-7"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Kuo F, Gillespie TA, Kulanthaivel P et al. Synthesis and biological activity of some known and putative duloxetine metabolites. Bioorg Med Chem Lett. 2004;14(13):3481\u20133486. doi: 10.1016\/j.bmcl.2004.04.066.","DOI":"10.1016\/j.bmcl.2004.04.066"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Knadler MP, Lobo E, Chappell J, Bergstrom R. Duloxetine: clinical pharmacokinetics and drug interactions. Clin Pharmacokinet. 2011;50(5):281\u2013294. doi: 10.2165\/11539240-000000000-00000.","DOI":"10.2165\/11539240-000000000-00000"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Moisset X. Neuropathic pain: Evidence based recommendations. Presse Med. 2024;53(2):104232. doi: 10.1016\/j.lpm.2024.104232.","DOI":"10.1016\/j.lpm.2024.104232"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Barohn RJ, Gajewski B, Pasnoor M et al. Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations (PAIN-CONTRoLS) Bayesian Adaptive Comparative Effectiveness Randomized Trial. [Published online 2020]; doi: 10.1001\/jamaneurol.2020.2590.","DOI":"10.1001\/jamaneurol.2020.2590"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Palmer RH, Periclou A, Banerjee P. Milnacipran: A Selective Serotonin and Norepinephrine Dual Reuptake Inhibitor for the Management of Fibromyalgia. Ther Adv Musculoskelet Dis. 2010;2(4):201. doi: 10.1177\/1759720X10372551.","DOI":"10.1177\/1759720X10372551"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Pickering G, Macian N, Delage N et al. Milnacipran poorly modulates pain in patients suffering from fibromyalgia: a randomized double-blind controlled study. Drug Des Devel Ther. 2018;12:2485\u20132496. doi: 10.2147\/DDDT.S162810.","DOI":"10.2147\/DDDT.S162810"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Clauw DJ, Mease P, Palmer RH, Gendreau RM, Wang Y. Milnacipran for the treatment of fibromyalgia in adults: a 15-week, multicenter, randomized, double-blind, placebo-controlled, multiple-dose clinical trial. Clin Ther. 2008;30(11):1988\u20132004. doi: 10.1016\/J.CLINTHERA.2008.11.009.","DOI":"10.1016\/J.CLINTHERA.2008.11.009"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Singh D, Saadabadi A. Venlafaxine. [Published online February 26]; xPharm: The Comprehensive Pharmacology Reference. 2024:1\u20135. doi: 10.1016\/B978-008055232-3.62846-6.","DOI":"10.1016\/B978-008055232-3.62846-6"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Naseeruddin R, Rosani A, Marwaha R. Desvenlafaxine. Indian J Psychiatry. 2023;51(4):320\u2013323. doi: 10.4103\/0019-5545.58303.","DOI":"10.4103\/0019-5545.58303"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Allen R, Sharma U, Barlas S. Clinical experience with desvenlafaxine in treatment of pain associated with diabetic peripheral neuropathy. J Pain Res. 2014;7:339\u2013351. doi: 10.2147\/JPR.S55682.","DOI":"10.2147\/JPR.S55682"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Krell HV, Leuchter AF, Cook IA, Abrams M. Evaluation of reboxetine, a noradrenergic antidepressant, for the treatment of fibromyalgia and chronic low back pain. Psychosomatics. 2005;46(5):379\u2013384. doi: 10.1176\/APPI.PSY.46.5.379.","DOI":"10.1176\/APPI.PSY.46.5.379"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Konuk N, Ortancil O, Bostanci B, Kiran S, Sapmaz P. A comparison of reboxetine and amitryptilline in the treatment of fibromyalgia syndrome with co-morbid depressive symptoms: An open-label preliminary study. Klinik Psikofarmakoloji Bulteni. 2010;20(1):29\u201337. doi: 10.1080\/10177833.2010.11790631.","DOI":"10.1080\/10177833.2010.11790631"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Arnold LM, Chatamra K, Hirsch I, Stoker M. Safety and efficacy of esreboxetine in patients with fibromyalgia: An 8-week, multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 2010;32(9):1618\u20131632. doi: 10.1016\/J.CLINTHERA.2010.08.003.","DOI":"10.1016\/J.CLINTHERA.2010.08.003"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Arnold LM, Hirsch I, Sanders P, Ellis A, Hughes B. Safety and efficacy of esreboxetine in patients with fibromyalgia: a fourteen-week, randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2012;64(7):2387\u20132397. doi: 10.1002\/ART.34390.","DOI":"10.1002\/ART.34390"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Arnold LM, Mease PJ, Thomas Z, Moton A, Tabuteau H. Long-Term Safety and Efficacy of Esreboxetine for the Treatment of Fibromyalgia. J Pain. 2024;25(4):34. doi: 10.1016\/j.jpain.2024.01.161.","DOI":"10.1016\/j.jpain.2024.01.161"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Ngian GS, Guymer EK, Littlejohn GO. The use of opioids in fibromyalgia. Int J Rheum Dis. 2011;14(1):6\u201311. doi: 10.1111\/J.1756-185X.2010.01567.X.","DOI":"10.1111\/J.1756-185X.2010.01567.X"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Edinoff AN, Kaplan LA, Khan S et al. Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations. Anesth Pain Med. 2021;11(4):e119156. doi: 10.5812\/AAPM.119156.","DOI":"10.5812\/AAPM.119156"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"da Rocha AP, Mizzaci CC, Nunes Pinto ACP, da Silva Vieira AG, Civile V, Trevisani VFM. Tramadol for management of fibromyalgia pain and symptoms: Systematic review. Int J Clin Pract. 2020;74(3) doi: 10.1111\/IJCP.13455.","DOI":"10.1111\/IJCP.13455"},{"key":"ref60","doi-asserted-by":"publisher","unstructured":"Bennett RM, Kamin M, Karim R, Rosenthal N. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: A double-blind, randomized, placebo-controlled study. American Journal of Medicine. 2003;114(7):537\u2013545. doi: 10.1016\/S0002-9343(03)00116-5.","DOI":"10.1016\/S0002-9343(03)00116-5"},{"key":"ref61","doi-asserted-by":"publisher","unstructured":"Qin L, Jiang F, Hu XQ. Effect of treating fibromyalgia syndrome with the combination of Tramadol and Amitriptyline. Chinese journal of rural medicine and pharmacy [zhong guo xiang cun yi yao za zhi]. 2009;16(3):18\u201319. https:\/\/www.cochranelibrary.com\/central\/doi\/10.1002\/central\/CN-00793155\/full.","DOI":"10.1002\/central\/CN-00793155\/full"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"Russell J, Kamin M, Bennett RM, Schnitzer TJ, Green JA, Katz WA. Efficacy of tramadol in treatment of pain in fibromyalgia. J Clin Rheumatol. 2000;6(5):250\u2013257. doi: 10.1097\/00124743-200010000-00004.","DOI":"10.1097\/00124743-200010000-00004"},{"key":"ref63","unstructured":"Biasi G, Manca S, Manganelli S, Marcolongo R. Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. [Accessed November 30, 2024]; Int J Clin Pharmacol Res. 1998 (1):13. https:\/\/thslc-houston.primo.exlibrisgroup.com\/discovery\/fulldisplay\/cdi_pubmed_primary_9604730\/01TEXASHEALTH_HOUSTON:TMC_INST."},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"Gilron I, Chaparro LE, Tu D et al. Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial. Pain. 2016;157(7):1532\u20131540. doi: 10.1097\/j.pain.0000000000000558.","DOI":"10.1097\/j.pain.0000000000000558"},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"Mease PJ, Farmer MV, Palmer RH, Gendreau RM, Trugman JM, Wang Y. Milnacipran combined with pregabalin in fibromyalgia: a randomized, open-label study evaluating the safety and efficacy of adding milnacipran in patients with incomplete response to pregabalin. Ther Adv Musculoskelet Dis. 2013;5(3):113\u2013126. doi: 10.1177\/1759720X13483894.","DOI":"10.1177\/1759720X13483894"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"Marlow NM, Simpson KN, Vaughn IA, Jo A, Zoller JS, Short EB. Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators. Pain Practice. 2018;18(2):154\u2013169. doi: 10.1111\/papr.12585.","DOI":"10.1111\/papr.12585"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"Abdel Fattah YH, Elnemr R. Efficacy of pregabalin as a monotherapy versus combined pregabalin and milnacipran in the management of fibromyalgia. Int J Rheum Dis. 2020;23(11):1474\u20131480. doi: 10.1111\/1756-185X.13953.","DOI":"10.1111\/1756-185X.13953"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"Ramzy EA. Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study. Pain Practice. 2017;17(1):32\u201340. doi: 10.1111\/papr.12409.","DOI":"10.1111\/papr.12409"},{"key":"ref69","doi-asserted-by":"publisher","unstructured":"Saad M, Medeiros R. Complementary Therapies for Fibromyalgia Syndrome\u2014A Rational Approach. Curr Pain Headache Rep. 2013;17(8):354. doi: 10.1007\/s11916-013-0354-7.","DOI":"10.1007\/s11916-013-0354-7"},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"Bruti G, Atencio MR, D\u2019Urso A, Di Giacomo P, Di Paolo C. Okada Purifying Therapy in combination with duloxetine vs. duloxetine alone in patients with TMD and fibromyalgia: a randomized clinical study. J Complement Integr Med. 2021;18(2):371\u2013377. doi: 10.1515\/jcim-2020-0116.","DOI":"10.1515\/jcim-2020-0116"},{"key":"ref71","doi-asserted-by":"publisher","unstructured":"Ang DC, Jensen MP, Steiner JL, Hilligoss J, Gracely RH, Saha C. Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia. Clin J Pain. 2013;29(9):747\u2013754. doi: 10.1097\/AJP.0b013e31827a784e.","DOI":"10.1097\/AJP.0b013e31827a784e"}],"container-title":["Psychopharmacology Bulletin"],"original-title":[],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:33:19Z","timestamp":1791315199000},"score":1,"resource":{"primary":{"URL":"https:\/\/medworksmedia.com\/pb-article\/serotonin-and-norepinephrine-reuptake-inhibitors-snris-for-treatment-of-fibromyalgia-a-comprehensive-clinical-review\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":71,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,12]]}},"URL":"https:\/\/doi.org\/10.64719\/pb.4519","relation":{},"ISSN":["2472-2448"],"issn-type":[{"value":"2472-2448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]}}}