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NHS article about B12 deficiency nhs.uk/conditions/vitamin-b

investigated the effectiveness of acetyl-l-carnitine in 28 patients with painful radiculopathies and neuropathies, including 17 with chronic lumbar radiculopathy, unresponsive/poorly responsive to previous treatment ( 30% pain relief) [50, 51]

Are there signs of tolerance or diminishing returns

Certain populations may require more frequent maintenance

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They noted that it may be an effective option to treat mild to moderate ED