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First-line options include gabapentin or pregabalin, tricyclic antidepressants such as amitriptyline or nortriptyline, topical lidocaine, and selected use of an 8% capsaicin patch

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No major professional medical organization recommends the peptide for any indication

The association between B12, homocysteine, and liver health becomes relevant because it explains exactly how vitamin deficiency leads to oxidative stress and eventual tissue damage