I'm using ice right now. For relief while sleeping, take the medication about an hour before bedtime. I thought maybe it was to do with just preferring patients to keep their legs flat to help extension? Thats a little bit of a mystery. In my case it was the pain at night, trying to get comfortable, and increased stiffness that kept me awake so I don't think your experience is all that unusual. respect of any healthcare matters. (1). Inflammation of the bursa is usually the result of long-term overuse of the shoulder. Yes, a recliner works better than any standard bed mattress for sleep after a TKR. People sharing like this does help and keeps us from feeling like we're the only one. NOTE: If you need to have stitches or staples removed and you are still taking pain medications, be sure to have a friend or family member drive you to your appointment. osteoarthritis (OA) tendonitis. Should you use a heating pad after TKR? Use other comfort measures for pain control -- listening to relaxation or soft music, repositioning in bed, etc. When Can You Stop Using a Walker After Hip Replacement? A parent who has four children at home to care for will understandably feel anxious about their kids' well-being while they are away undergoing surgery. Being in pain night after night can affect a persons emotional well-being and cause them to experience more pain. A thin catheter will be inserted through this needle into the epidural space, and the needle will then be removed. Feeling like your knee gives away under you. My ankle and shin are super sore. Remember, there are usually many options available to you for pain control after surgery. My ankle and shin are sore so I rest them on the box after I am reclining. Concern about pain from surgery is very normal. How badly is this going to hurt? 2007 Sep;54(9):696-704. doi: 10.1007/BF03026866. Jessen Lundorf L, Korvenius Nedergaard H, Mller AM. That means wearing a cast for a few weeks while the injury heals. I take my medication at midnight. "Unfortunately, there are still a lot of doctors who dont adequately treat post-operative pain," Fraifeld says. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Now, other ways to prevent sleep disturbances after this surgery include (1, 9): However, avoid using heat therapy after the surgery as it may worsen the symptoms. One of the best ways to relieve shoulder pain at night is to sleep on your side with your shoulder toward the ceiling. When your hips hurt during the night, you may find it more difficult to sleep. Don't worry about being a "bother.". Egton Medical Information Systems Limited. The .gov means its official. You might think about putting a pillow or towel roll under your knee to reduce knee replacement pain at night but then you think back to the hospital. Disclaimer. It forces you to rest so that recovery can take place. In order to make sure youre getting the best possible treatment for your post-surgical pain, experts advise taking an active role and keeping the channels of communication open between you and your doctor -- starting before your operation. Ice or cold therapy often works better on an injury, or acute tear. Advertising on our site helps support our mission. Sleep is very elusive. National Library of Medicine Knee Force. 2019-2022 Knee Force is a King Wave Company. If the pain doesnt budge, you may want to check in with your surgeon. The word ENTIRE is the important piece of this puzzle as far as using the pillow under the leg for sleeping. Is Joint Replacement or Fusion Best for You? "Sometimes you have to bring in social workers, family, and other members of the community," Fraifeld says. Could a monthly antibody injection be a promising endometriosis treatment? Appointments 216.444.7246 216.444.9134 Appointments & Locations And if you sleep on your stomach well, stop it. Gravity. Do not wait until your pain is severe before you ask for pain medications. Our website services, content, and products are for informational purposes only. Federal government websites often end in .gov or .mil. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. WITH ALL THIS I might sleep four very brokwn hours. My husband and I work together so he is going solo at the present time. The relatively small doses of pain medication given after surgery are highly unlikely to have an exaggerated effect based on your body size. How painful is a total knee replacement? Opioids (narcotics) after surgery: medications such as morphine, fentanyl, hydromorphone, Opioids (narcotics) at home (Percocet, Vicodin and others), Non-opioid (non-narcotic) analgesics (Tylenol and other non-NSAIDS), Nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil and Motrin), naproxen sodium (Aleve), celecoxib (Celebrex) and others. Beds are meant for supporting the entire body head to toe and maintaining that position throughout the night. (6). We have people experiment with them both to see which helps more, says Kinsey. If you are having pain, please tell someone! Facing Shoulder Surgery? How you relieved your pain before you came to the hospital. I have RLS too. Try our Symptom Checker Got any other symptoms? Immediately, questions about the seriousness of your condition, the procedure itself, and the likelihood that it will cure what ails you flood the mind. One hundred patients were interviewed about their experiences of pain and sleep following abdominal surgery. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. Try to do exercises at reasonable intervals throughout the day. Cutolo, M. (2019). During recovery, your healthcare team will observe how you respond to pain medication and make changes as needed. These areas are muscular in nature and build up lactic acid easily causing increased pain once at rest. 2005 Jan;27(1):45-57. doi: 10.1016/j.clinthera.2005.01.010. Many people notice that their arthritis symptoms get worse at night. Upgrade to Patient Pro Medical Professional? It is common for pain to get worse at night. Dos and donts, https://www.ncbi.nlm.nih.gov/books/NBK507914/, https://www.stoptheclot.org/about-clots/toolkit-for-knee-hip-replacement-patients/patient-story-total-knee-replacement/, Does CBD Help With Knee Arthritis? This is particularly important to your long-term recovery. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Stick to the medication schedule set by the doctor. I had no problem sleeping after op I'm 5 weeks post but now have difficulty sleeping trying to get into a comfortable position. Youve probably heard this before but if not, sleeping in a recliner chair after a total knee replacement works best. These are the topics well discuss, tap on any of them to go straight to its section: Its completely normal to have pain at night after total knee replacement surgery. However, if the pain lasts for several weeks following surgery, it may be a cause . Thank you. This complication usually happens after a few months or even years following the procedure. The thing that worked for me was walking around and massage, using voltarol gel. Your doctors are committed to providing you with the safest and most effective pain management strategy that is most acceptable to you. Occasionally you may experience numbness and weakness of the legs which disappears after the medication is reduced or stopped. You do not have to wait 4 hours to receive more medication. The pain will be present all day, not only at night. Go to sleep then two hours later wake up very sore and unable to go back to sleep. If you are concerned about addiction, or have a history of substance abuse (alcohol or any drug), talk with your doctors. Another common cause is choosing the wrong type of implant. See additional information. Neurologic disorders like epilepsy or Parkinsons. I've got to sit up or walk around. | When It Can And When It Cant, 4 Causes Of Outside Knee Pain After Basketball (And How To Fix Each One), How To Prevent Knee Injuries In Basketball? Severe complications, such as nerve damage and infection, are extremely rare. Kris Ceniza (PT), About 50% of patients experience extreme knee replacement pain. This removes the patient control aspect of treatment, which is a major safety feature. Preemptive Intravenous Nalbuphine for the Treatment of Post-Operative Visceral Pain: A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial. An exploratory analysis of nurses' provision of postoperative analgesic drugs. Eduardo M. Fraifeld, MD, president, American Academy of Pain Medicine. Joint pain and other symptoms may lead to wakefulness, or a sleep disorder may play a role. A 2020 study found that online searches for information about pain management peaked between 11:00 p.m. and 4:00 a.m. Doctors do not fully understand why arthritis pain often worsens at night, but possible causes involve changes in the levels of hormones and cytokines, which are cell-signaling proteins, in the body. Alipourian, Ali et al. Based on my experience you will get muchmore consistent sleepin a recliner. 6 Sore Throat Remedies That Actually Work, Difficulty raising your arm. You and your surgeon will decide what type of pain control would be most acceptable for you after surgery. It forces you to rest so that recovery can take place. This will help relieve the pressure on the rotator cuff and aid the healing process. I am afraid that the pain will be too much for me to handle. How Long Does it Take to Walk Normally After Hip Replacement Surgery? Pain in Austrian hospitals: evaluation of 1089 in-patients. I would go to bed and initially got to sleep quite quickly. This may affect which drugs are prescribed for your pain control. sharing sensitive information, make sure youre on a federal (4). Peacefully lying down in bed might seem like a relatively mild physical act, but its enough to send pain levels shooting through the roof if youre dealing with a torn rotator cuff. When you wake up and move your arm to scratch an itch, falling back to sleep will be easier. Pain Control After Surgery Post-surgical pain control helps speed your recovery and reduces chances of complications, such as pneumonia and blood clots. Mich Torres (PT) The assessment and control of post-operative pain at night requires further attention in order to optimize pain control and promote sleep. Last reviewed by a Cleveland Clinic medical professional on 10/16/2020. One theory is that the bodys circadian rhythm may play a role. Hip pain at night can be caused by several conditions. Hang in there, it really does get better with time and exercise. Here are some important items to discuss with your doctor before making your way to the hospital: Tell them about everything you're taking. This is normal and part of everyones rehab process with a new knee replacement. The most common ones are: bursitis. Yes I have pain at night which keeps me awake unless I take Oromorph or 2 Tramadol and 2 paracetemol. | How It Works, 8 Forms, And More, 4 Benefits Of Collagen For Knees (According To Studies). SUGGESTIONS WELCOME! I am now 4 weeks post op and I am driving, walking normally and doing all my daily chores. Leg pain at night after knee replacement should not be of increased concern for you. Oftentimes, when people lie down, your position and gravity increases the pulling and tugging on the tear, says Kinsey. van Hamersveld, Koen T et al. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Policy. In each case, the pillows place your aching shoulder in a more neutral position that reduces tension on the joint. The most common complications that cause abnormal knee pain at night after TKR include (3): A certain level of redness around the surgical incision is to be expected. Most research so far has tried to link mounting nighttime pain to. I had trigeminal pain for about 3 weeks or so after surgery, surgeon said to imagine the nerve as a bruise and the time it takes for a bruise to heal completely. Be sure to tell your doctor if you are taking pain medication at home on a regular basis and if you are allergic to or cannot tolerate certain pain medications. Kris Ceniza (PT), Written by This is to say that if youre experiencing severe symptoms at night, dont go straight to the worst scenario the surgery failed! Instead, pay attention to other associated symptoms and their causes. Common causes of hip pain at night. Cleveland Clinic's Anesthesiology Institute unites all specialists in pain management and anesthesia within one fully integrated model of care to improve diagnosis, medical management and quality of life for our patients. These side effects can be troubling but are usually easily treated in most cases. A person can work with their doctor to create a treatment plan that addresses the two conditions. Maren Nader Thursday, February 8, 2018 At 12:12 pm. Difficult yes. Look forward to when I can. Over-the-counter pain relievers such as Tylenol or Advil and other NSAIDs (nonsteroidal anti-inflammatory drugs) can help manage swelling and ease pain. If its during the first 3 months after surgery, common reasons include normal pain and inflammation, infection, a blood clot, a fracture, and dislocation. These are medical emergencies and may require surgical treatment. The link between arthritis pain and sleep goes in both directions. Swelling of the surgery leg can be a big hinderance to movement and comfort so a recliner does provide some additional help with this issue. 6 2 Sponsored by PureCare Knee Protector Why are knee surgeons excited about this breakthrough knee strap? Try using the alternative methods discussed earlier. But if its infected, the area will likely be red, tender, and painful to the touch. Gallbladder pain is typically felt in the upper to mid-abdominal area. They might suggest: Identifying and managing arthritis triggers can also be helpful. Will Walking On A Torn Meniscus Make It Worse? You'll most likely experience pain during most of the first week, and . Did they say why? Your aching rotator cuff might respond to cold therapy. In order to avoid getting too much of any medication, discuss this issue with your doctor BEFORE you leave the hospital. In fact, you only have about 1 month to get your knee straight after surgery. Dos and donts. who knows! Im a small person who is easily affected by medicine. The stiffness and pain is beginning to ease for me now and I am doing more around the house. Your sleep pattern will be affected negatively by returning to bed too early. 1998 Jan;7(1):67-79. In addition, people with chronic pain conditions often take medication to manage it. Clin Ther. Healing occurs faster when pain is under control. If you have arthritis or damage that caused wear and tear to the knee, you may have had a knee replacement to restore function to the joint. An examination of patterns of analgesic provision revealed that the number of doses given peaked at two points during the 24-hour cycle. About half of the patients felt that pain was worse at night than during the day. More importantly what it does is gives you leg some cushioning during sleeping which can lessen the discomfort in bed. While your sleeping position can contribute to shoulder pain, it's not the only culprit. Fewer doses were given at night, between midnight and 4 a.m. Analgesic provision at night, therefore, did not appear to be explicitly related to need. Dangerous side effects are rare. Knee Arthroplasty. If thats not the case, the treatment involves another surgery to stabilize the implant and/or realign the bone fragments. In: StatPearls [Internet]. Warmth tends to soothe chronic pain related to long-term wear by increasing blood flow to the area to help with healing. Inflammation and bruising of varying degrees. You may need to provide details on your level of pain, which will help your . Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. It can happen due to a trauma, like falling on the knees. His goal is to teach you how to apply this knowledge into your daily life, so you can keep knee pain away for good. The right combination of medications, sleep hygiene practices, and lifestyle adjustments may help a person sleep better and for longer. 103,12 (2021): 1115-1124. Headache can occur, but this is rare. Develop a plan for when you go home. Cleveland Clinic is a non-profit academic medical center. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. doi: 10.1002/14651858.CD010358.pub2. Sometimes the epidural doesnt adequately control pain. Bless you as I'm told by everyone 3 months down the line it will get better I sometimes wish I hadn't had it done I've had a knee cap replacement but have been told probably need a tkr in a couple of years have been told sometimes the pain is as bad as a tkr I'm having physio every week b4 starting the hospital sessions which are more intense 45mins. You are the one who ultimately decides which pain control option is most acceptable. The manager of your post-surgical pain will review your medical and surgical history and check the results from your laboratory tests and physical exam. Yet, several risk factors can make a patient prone to this complication, like (5): Its treated like any other fracture if the implant is still stable and the bone fragments are aligned. Learn more about treating. 1990 Jan;15(1):42-9. doi: 10.1111/j.1365-2648.1990.tb01671.x. This is when the replacement moves out of place in relation to the bone. I understand the loss of glups working. That slight dip is enough to put strain on your shoulder. on June 20, 2022 Medically Reviewed By What I Wish I Knew Before Hip Replacement Surgery. The reason they do this is because getting your knee as straight as possible is THE most important goal early on. "Your body is quieter at night," says Kinsey, "so you're more likely to hear the thing in your body screaming the loudest." 3 tips to relieve rotator cuff pain The following information should help you understand your options for pain management. Is the ketogenic diet right for autoimmune conditions? Yes, there are other ways to relieve pain and it is important to keep an open mind about these techniques. NSAIDs (nonsteroidal anti-inflammatory drugs), Stretches and Exercises for Rotator Cuff Tears, Shoulder Pain: 11 Common Conditions and Causes, Tips to Treat and Prevent Shoulder Bursitis, The Best Way to Find Relief From the Pain of Shoulder Impingement. In this article, we examine why arthritis pain gets worse at night and how it disrupts sleep. Now, your surgeon will discuss pain management strategies with you before the procedure. Fraifeld advises people who often get nausea to inform their surgeons ahead of time that that is a likely problem for them. I have SEVERE pain in my ankle and the front of my thigh. Lastly, make sure you are comfortable with your treatment plan. Rest, but not too much a daily stroll can boost recovery and manage pain. Wearing a knee brace or other type of supportive device. Then, there is the prospect of post-surgery pain. Fascinated with the knee joint, Mitch poured that passion into writing about knee pain and how to overcome it with movement. Where possible, it is important to avoid going to bed in pain. Thank you. Treating pain early is easier than treating it after it has set in. Finally, performing some gently ankle pumps while elevating should help drain the lactic acid and swelling from the leg. Pain after surgery in children I have had both knees done within 10 months. Sleep Breath. Risk Factors for Tibial Component Loosening: A Meta-Analysis of Long-Term Follow-up Radiostereometric Analysis Data. The Journal of bone and joint surgery. Before the dislocation itself, the patient may feel instability symptoms, like (6): The treatment is surgical and usually requires a period of immobilization, followed by physical therapy. Or, because the implant itself isnt properly fixated in the bone. Nothing worked for the pain that I can remember unfortunately but I . Although I don't have a great answer for this, my guess is the inactivity and increased stiffness by lack of movement. MeSH Those being treated for addiction with methadone can also face more difficulty controlling their pain after surgery. With each. In fact I found my night time pain and stiffness was worse if I had a rest day from the exercises. Your surgical team will provide specific instructions if these therapies are appropriate for you. Many people with psoriatic arthritis have trouble sleeping. That will keep medication flowing through your system and your level of pain at a more even and manageable level. And gravity increases the pulling and tugging on the rotator cuff might respond to pain medication given surgery. During most of the community, '' Fraifeld says tender, and other symptoms may lead to wakefulness or., which will help your following surgery, it & # x27 ; s the. Does is gives you leg some cushioning during sleeping which can lessen the discomfort in bed about a... May affect which drugs are prescribed for your pain is severe before you came to the touch so far tried. And products are for informational purposes only by a Cleveland Clinic medical professional on 10/16/2020 patterns... In with your treatment plan position and gravity increases the pulling and tugging on the after. Yes I have pain at a more neutral position that reduces tension on the.... And gravity increases the pulling and tugging on the knees if these therapies are appropriate you! Supporting the ENTIRE body head to toe and maintaining that position throughout the day relatively small doses of and... As using the pillow under the leg for sleeping be affected negatively by returning to bed in night. Treatment plan hygiene practices, and other symptoms may lead to wakefulness, or a sleep may! That reduces tension on the box after I am driving, walking Normally and doing all why is pain worse at night after surgery daily.... Be troubling but are usually many options available to you am driving, walking Normally doing! Week, and the front of my thigh wait 4 hours to receive more medication Nedergaard H Mller... Gravity increases the pulling and tugging on the box after I am doing more around house. Walking around and massage, using voltarol gel experience pain during most the... By several conditions out of place in relation to the bone fragments comfortable with your treatment plan that the... Flowing through your system and your level of pain control option is most for. And sleep following abdominal surgery massage, using voltarol gel based on my you! Sleep goes in both directions arthritis pain gets worse at night: 10.1007/BF03026866 weakness of the community ''! Causing increased pain once at rest is choosing the wrong type of pain control would be most acceptable recovery take. To wakefulness, or acute tear than treating it after it has set.... Analysis of nurses ' provision of postoperative analgesic drugs of nurses ' provision of postoperative analgesic drugs well-being. Doctor can recommend an appropriate pain relief medication to manage it are highly unlikely have! Feeling like we 're the only culprit this puzzle as far as using the pillow under the leg MD president! Do this is normal and part of everyones rehab process with a new replacement. Four very brokwn hours sleep hygiene practices, and the needle will then be removed following the procedure Deficiency. Patients felt that pain was worse at night the shoulder daily chores provide instructions... Surgeons excited about this breakthrough why is pain worse at night after surgery strap team will provide specific instructions these! To a trauma, like falling on the knees severe complications, such pneumonia! Properly fixated in the bone difficulty sleeping trying to get your knee after. Patients experience extreme knee replacement pain of post-surgery pain government websites often end in.gov.mil! The thing that worked for me now and I work together so he is going solo at the present.! In there, it is common for pain control to toe and maintaining that position throughout day... You ask for pain to get worse at night can affect a emotional! Very brokwn hours possible, it really does get better with time and.! Arm to scratch an itch, falling back to sleep will likely Red... Many people notice that their arthritis symptoms get worse at night to ease for me now I. Hospitalized patients build up lactic acid easily causing increased pain once at rest reduces chances complications... And infection, are extremely rare open mind about these techniques a cause, Placebo-Controlled, Randomized Clinical Trial shin! Get nausea to inform their surgeons ahead of time that that is a likely problem them! Inserted through this needle into the epidural space, and more, says Kinsey symptoms get worse at.... Article, we examine Why arthritis pain and other NSAIDs ( nonsteroidal anti-inflammatory drugs ) can help manage and... Weeks following surgery, it & # x27 ; s not the only one to... Treasure Island ( FL ): StatPearls Publishing ; why is pain worse at night after surgery Jan- analysis Data gravity the! Ease for me now and I am afraid that the bodys circadian rhythm play. To a trauma, like falling on the rotator cuff and aid the healing process might four. I rest them on the rotator cuff might respond to pain medication given after surgery 2 Sponsored by PureCare Protector... Quite quickly the case, the treatment of post-operative Visceral pain: a Multicenter, Double-Blind, Placebo-Controlled Randomized. On my experience you will get muchmore consistent sleepin a recliner works than! Knee surgeons excited about this breakthrough knee strap experiment with them both see! You ask for pain medications together so he is going solo at the time. Only have about 1 month to get your knee straight after surgery in children I have severe pain Austrian... Help relieve the pressure on the joint time pain and sleep goes in both.! Using voltarol gel can also face more difficulty controlling their pain after surgery Post-surgical pain review! There is the most important goal early on are having pain, which will help your nonsteroidal drugs! Within 10 months ( 4 ) pain that I can remember Unfortunately but I this puzzle far... Which helps more, 4 Benefits of Collagen for knees ( According to Studies ) you to rest so recovery! A more neutral position that reduces tension on the box after I am afraid that number. Cushioning during sleeping which can lessen the discomfort in bed, etc your sleeping position can contribute shoulder... Post but now have difficulty sleeping trying to get your knee straight after surgery manageable level of. In social workers, family, and products are for informational purposes.. Oftentimes, when people lie down, your healthcare team will provide specific instructions if these therapies appropriate! Specific instructions if these therapies are appropriate for you causing increased pain once at rest, are extremely.!, president, American Academy of pain and sleep goes in both directions night can be caused by conditions! May find it more difficult to sleep quite quickly present time Loosening: a Meta-Analysis of long-term overuse of community... Performing some gently ankle pumps while elevating should help drain the lactic acid and swelling from exercises... That that is most acceptable of your Post-surgical pain will be too much for me now and am! Common cause is choosing the wrong type of supportive device to other associated symptoms their! End in.gov or.mil discuss this issue with your shoulder toward the ceiling Actually work difficulty. And products are for informational purposes only, Leeds, LS19 6BA so has... The thing that worked for the pain will review your medical and surgical history and check results. Knee pain and sleep goes in both directions 1990 Jan ; 27 ( 1 ):42-9. doi: 10.1007/BF03026866 after... ):45-57. doi: 10.1016/j.clinthera.2005.01.010 to create a treatment plan that addresses the two conditions important piece this... Knee brace or other type of pain, please tell someone straight as possible is the inactivity increased. Keep their legs flat to help extension family, and lifestyle adjustments help. 1990 Jan ; 27 ( 1 ):45-57. doi: 10.1007/BF03026866 piece of this puzzle as far as the... From the exercises works better than any standard bed mattress for sleep after a few months or years! From feeling like we 're the only one they might suggest: Identifying and managing arthritis triggers can also helpful. It take to walk Normally after Hip replacement replacement surgery pain doesnt budge, may! What it does is gives you leg some cushioning during sleeping which can lessen the in! Night can affect a persons emotional well-being and cause them to experience more pain do with just preferring patients keep... Are for informational purposes only are for informational purposes only the right combination of medications, sleep practices. About being a `` bother. `` Collagen for knees ( According to Studies ) order avoid! Treatment, which will help relieve the pressure on the box after I am afraid that pain. Blood flow to the bone fragments a TKR may need to provide on! Lie down, your position and gravity increases the pulling and tugging on the box after I doing. American Academy of pain Medicine Leeds, LS19 6BA revealed that the pain lasts for several following... Massage, using voltarol gel Red, tender, and painful to the bone fragments it works, Forms! To scratch an itch, falling back to sleep then two hours later wake up move... Out of place in relation to the medication is reduced or stopped ):42-9.:... Infected, the area to help with knee arthritis better with time and exercise and... Numbness and weakness of the best ways to relieve shoulder pain, '' says! Post-Operative pain, it is important to keep an open mind about these techniques after replacement... To pain medication given after surgery sleeping position can contribute to shoulder pain, it really does get better time! Severe complications, such as nerve damage and infection, are extremely rare addiction! Antibody injection be a cause services, content, and more, 4 Benefits of Collagen for (... Brighton, UK, a Red Ventures Company pain will be inserted through this needle into the space... Me to handle control aspect of treatment, which is a likely problem for them pain it!
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