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Maybe the fuel delivery system?

I'd consider TOP ENGINE CLEANER for the intake, a WHOLE BUNCH of fuel injector cleaner for a few tanks, a new fuel filter ... possibly a new pump. I'm thinking that you COULD be having issues delivering the amount of fuel the engine requires: more fuel for towing plus higher RPMS plus climbing a hill. Under normal conditions, you may be within the capabilities of your old fuel system. Under heavier loads, you might be JUST outside of it.

This is ALL a big MAYBE. Just a thought.
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