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Valget af kraftigt virkende medicin i smertebehandling er en opvejning mellem bivirkninger og virkning samt hvor stærke smerterne er.Ved langvarige smerter er det mange som erfarer at andre smertelindrende metoder enn legemidler er det som hjelper best. Hvis TCA har været forsøgt i fuld dosis uden effekt er det teoretisk mindre sandsynligt, at

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