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J Pain Palliat Care Pharmacother. 2008, 22:54-7. 10.1080\/15360280801989450","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"ref35","unstructured":"Medications and the Liver. Overview. (2007). Accessed: 7th September 2023: https:\/\/gi.org\/topics\/medications-and-the-liver."},{"key":"ref36","unstructured":"The American Liver Foundation Issues Warning on Dangers of Excess Acetaminophen. (2006). http.\/\/www.liverfoundation.org\/downloads\/alf_download_39.pdf."},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02376.x","article-title":"Pharmacological management of persistent pain in older persons","volume":"57","year":"2009","unstructured":"Pharmacological management of persistent pain in older persons. 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