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In the general population, tramadol also carries risks for hypoglycemia, hyponatremia, and serotonin syndrome, and a recent systematic review found only modest pain relief with increased serious adverse events [18,19,20].These risks are particularly concerning in patients with cirrhosis, who are already predisposed to metabolic derangements

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For example, a 2022 meta-analysis evaluated the effectiveness of acupuncture, intravenous lidocaine, and diet compared to other treatments, such as physiotherapy and placebo, in patients with FM

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