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This modulation of inflammatory signaling occurs through activation of the PI3K/AKT pathway, which possesses intrinsic anti-inflammatory properties including inhibition of pro-inflammatory cytokine release and enhancement of cellular stress resistance

A meta-analysis published in 2023 that included this trial and four other treatment trials conducted since that time concluded that duloxetine is only associated with a modest trend toward pain reduction and that this is accompanied by a similar trend in increased adverse events, suggesting a need for additional well-designed trials to support its continued use in this setting (Chow 2023)