Näytönastekatsaukset

SNRI medications in treatment of fibromyalgia

Näytönastekatsaukset
3.3.2026
Aleksi Varinen and Aleksi Raudasoja

Level of evidence: B

SNRI medications likely decrease fibromyalgia symptoms and fibromyalgia-related pain slightly.

A Cochrane review on SNRI medications to treat fibromyalgia symptoms «Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 »1 found small impact on the total symptoms and fibromyalgia-related pain. The average pain decreased by about 11% in comparison to the control. The impact was similar on the fibromyalgia-related quality of life (i.e. total symptoms).

SNRI medications increased the risk of nausea (RD 16%), somnolence (RD 5%) and insomnia (RD 3%).

We downgraded the level of evidence due to study limitations (high dropout rates).

Table 1. Description of the included studies
Reference Study type Population Intervention and comparison Outcomes Risk of bias
RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; BPI = brief pain inventory FIQ = fibromyalgia impact questionnaire
«Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 »1SR/MAAdults with fibromyalgiaSNRI vs placebo Mean pain intensity, Side effectsmoderate
Table 2. Additional comments for included studies
Reference Comments
«Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 »1 Included studies on duloxetine and milnacipran. High dropout rates. randomization and blinding ok. Measured side effects: Nausea, Somnolence, Insomnia.
Table 3. Outcome 1 – Mean pain intensity [scale 0-11]
Reference Number of studies and number of patients (I/C) Follow-up time Mean change from baseline (sd) I Mean at follow up C Mean difference (95% CI)
Level of evidence: moderate
The quality of evidence is downgraded due to study limitations.
I=intervention; C=comparison; CI=confidence interval
*Calculated with the pooled standard deviation
«Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 »1 16 studies (4141/2873)6-26 weeks - -SMD – 0,22 (-0,27 to -0,17)
Translates to MD of -0,55 (-0,68 to -0,425)*
Relative decrease
-11% (-13% to -8%)
Table 4. Outcome 2 – Fibromyalgia related quality of life (i.e. total fibromyalgia symptoms) [scale 0-100]
Reference Number of studies and number of patients (I/C) Follow-up time Mean change from baseline (sd) I Mean at follow up C Mean difference (95% CI)
Level of evidence: moderate
The quality of evidence is downgraded due to study limitations.
I=intervention; C=comparison; CI=confidence interval
«Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 »1 14 studies (4060/2801)6-26 weeks - -SMD – 0,20 (-0,25 to -0,15)
translates to
MD -5,0 (-6,25 to -3,75)
Table 5. Outcome 3 – Self reported pain relief of 50% or greater
Reference Number of studies and number of patients (I/C) Follow-up time Events (%) I Events (%) C Risk difference (95% CI)
Level of evidence: moderate
The quality of evidence is downgraded due to study limitations.
I=intervention; C=comparison; CI=confidence interval
«Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 »1 15 studies 6918 participants6-26 weeks 1274 (31%) 591 (21%)0,09 (0,07-0,11)

References

  1. Welsch P, Üçeyler N, Klose P, et al. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev 2018;2(2):CD010292 «PMID: 29489029»PubMed