Evaluation of the Antinociceptive and Analgesic Effects of Milnacipran

Inclusion Criteria: * patient with FMS according to the 1990 ACR criteria * patient willing to withdraw from CNS-active therapies commonly used for FMS, including anti-depressants, anti-convulsivants, opiates * patient willing to discontinue treatment with tender and trigger point injections, joint injections and anesthetics Exclusion Criteria: * severe psychiatric illness * current Major Depressive Episode (MDE) * significant risk of suicide * history of substance abuse * epilepsy * myocardial infarction in the past 24 months * active cardiac disease * congestive heart failure * prosthetic heart valve * haemodynamically significant valvular heart disease * known cardiac rhythm anomalies or conduction abnormalities * unstable and uncontrolled arterial hypertension or supine arterial blood pressure over 160/90 mmHg * pulmonary dysfunction * active liver disease * renal impairment * documented autoimmune disease * current systemic infection * active cancer, except basal cell carcinoma or current cancer therapy * severe sleep apnoea * active peptic ulcer or inflammatory bowel disease (except IBS) * unstable endocrine disease * pregnancy or breastfeeding * concomitant use of non selective MAO inhibitors, MAO-A or -B inhibitors, tricyclics, tetracyclics, SSRIs, NARIs, SNRIs, epinephrine, norepinephrine, clonidine and related compounds, long-acting benzodiazepines * concomitant use of oral anticoagulants, anticonvulsants, type Ic antiarrythmics, lithium * concomitant use of hypericum and SAMe * concomitant use of digitalis preparations * regular use of centrally-acting muscle relaxants * concomitant use of strong analgesics, including tramadol, codeine or opiates * any factor known to affect the HPA axis or autonomic function such as cigarette smoking (regularly over 25 cigarettes a day)