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In later, larger studies, amitriptyline was used as active comparator to gabapentin, pregabalin, and duloxetine, and was shown to have similar effects in relieving DPN pain as these other drugs [57-59]

Supporting this notion, in a recent study made on people with severe obesity undergoing bariatric surgery, the hepatic content of dihydroceramide, which is considered a marker of de novo synthesis of ceramides, and ceramides were markedly increased in subjects with higher HOMA-IR (68)