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Chronic pain produces significant physiologic effects through neuroplastic changes in central nervous system pain pathways, dysregulates neurotransmitters such as substance P (an 11amino acid neuropeptide that functions as a neurotransmitter and modulator in both the central and peripheral nervous systems) and glutamate, and disrupts descending inhibitory pathways (3)(5)

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The most common are gastrointestinal: nausea, vomiting, diarrhea, decreased appetite, and constipation