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S Serotonin & Norepinephrine reuptake inhibition Enhances descending pain inhibition pathways. T Tolerance Can develop with prolonged use. U Use in chronic pain For long-term pain when non-opioids fail. V Vomiting/nausea Common adverse effect. W Withdrawal symptoms Anxiety, sweating, insomnia, tremors if stopped abruptly. X X-factor (dual action) Makes it unique among opioids. Y Yield of pain relief Moderate efficacy, especially for neuropathic pain. 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