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Blood sugar fluctuations, insulin resistance, and mitochondrial strain increase: Oxidative stress Pro-inflammatory cytokine signaling Nervous system reactivity Impaired cellular recovery Even subtle metabolic instability can make pain more persistent and resistant to conventional treatment

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For AC, which frequently exhibits poorer outcomes with standard radiotherapy, trials could test intensified local approaches such as drug-eluting hydrogels carrying radiosensitizers or immune-priming agents, within a biomarker-driven framework