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In this regard, the use of validated scales such as the Örebro musculoskeletal pain screening questionnaire and the STarTBack tool, which contain questions about pain duration, emotional distress, fear-avoidance beliefs, self-perceived functioning, and expected return to work, may help assess psychological and social factors that are linked with an understated or overstated response to the treatment

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treatment often starts with an aggressive loading dose of 1000 mcg injections several times a week before tapering to monthly or bimonthly shots once levels stabilize