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BPC-157 may not be appropriate when: Imaging or specialist review has not yet been completed for a suspected structural injury There are acute red flag features (severe weakness, fever, rapid unexplained swelling, neurological changes, unexplained weight loss) The patient has active cancer or a history of certain cancers where angiogenic peptides require careful risk assessment The goal is rapid results without addressing underlying load, rehabilitation, or lifestyle drivers A peptide should not be used to delay evaluation that is clearly warranted

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JAMA Internal Medicine, 173 (5), 355-361