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Watch for worsening pain and spreading redness beyond the immediate area after 48 to 72 hours, fever, a hard warm lump, or systemic allergic symptoms such as hives, facial swelling, throat tightness, or breathing difficulty

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A stressor such as public speaking produces an increase in intestinal permeability with an increase in cortisol levels

Pain relief, when achieved, typically lasts several months

doi: 10.1159/000368833 40 SuganamiTNishidaJOgawaY