Fibromyalgia is a chronic disorder of uncertain aetiology, more common in women than in man, characterized by widespread pain, muscle tenderness and decreased pain threshold to pressure and other stimuli. The pathophysiology of fibromyalgia is still unknown, but some evidences suggest that abnormalities in central monoaminergic transmission might play an important role. These abnormalities include dysfunction in both serotonin (5-HT) and norepinephrine (NE) systems. In addition, fibromyalgia frequently presents in comorbidity with depression and anxiety disorders. On these basis antidepressants are the most widely studied drugs and, probably the most effective therapy of fibromyalgia. Until now amitriptyline, a tricyclic antidepressant, was considered the most effective, with some evidence of efficacy for other antidepressant such as the SSRI fluoxetine and sertraline. Here we review the efficacy and safety of duloxetine, a SNRI antidepressant, in the management of fibromyalgia.