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In addition to palpation of three external sites (bilateral sacroiliac joints, medial edge of the anterior superior iliac spine, and cephalad edge of the pubic symphysis) to screen for the presence or absence of self-reported pain, the examination includes internal vaginal palpation of the pelvic floor muscles

Dosing starts low and increases gradually over several months to improve tolerability

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Understanding the multifactorial nature of fatigue helps set realistic expectations for patients initiating therapy