A Cochrane review on SNRI medications to treat fibromyalgia symptoms «Welsch P, Üçeyler N, Klose P, et al. Serotonin and...»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).
| 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...»1 | SR/MA | Adults with fibromyalgia | SNRI vs placebo | Mean pain intensity, Side effects | moderate |
| Reference | Comments |
|---|---|
| «Welsch P, Üçeyler N, Klose P, et al. Serotonin and...»1 | Included studies on duloxetine and milnacipran. High dropout rates. randomization and blinding ok. Measured side effects: Nausea, Somnolence, Insomnia. |
| 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 |
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| «Welsch P, Üçeyler N, Klose P, et al. Serotonin and...»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%) |
| 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 |
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| «Welsch P, Üçeyler N, Klose P, et al. Serotonin and...»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) |
| 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 |
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| «Welsch P, Üçeyler N, Klose P, et al. Serotonin and...»1 | 15 studies 6918 participants | 6-26 weeks | 1274 (31%) | 591 (21%) | 0,09 (0,07-0,11) |