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Identifying ongoing contributorsincluding delayed diagnosis, untreated co-infections, autonomic dysfunction, persistent infection in selected patients, or other medical conditionsmay improve outcomes in some individuals

doi:10.1016/j.phymed.2016.12.003

I have also had similar symptoms on a couple of occasions and it is normally after a long period without B12 and then a going back on it too quickly

The needle tip dulls after a single puncture, making subsequent injections more painful and causing more tissue damage

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