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If a patient does not respond to the first-line therapy (amitriptyline, cyproheptadine, and/or propranolol) the following options should be considered: (1) presence of persisting triggers (e.g., psychological stressors) and comorbid conditions (e.g., anxiety, POTS) or missed underlying disorders (e.g., hydronephrosis, chronic sinusitis, acute appendicitis, intestinal malrotation with volvulus, CNS tumors, metabolic crises) and toxic exposure (e.g., cannabis)

Due to the fact that liquid carnitine is absorbed faster than capsules or tablets, it can deliver profound benefits more rapidly, thus making it ideal for pre-workout use when quick and simple consumption matters

This approach can also be helpful for detecting food sensitivities that contribute to co-occurring pain conditions such as fibromyalgia and irritable bowel syndrome

doi: 10.1093/hmg/ddv183