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Overview

Postherpetic Neuralgia: Treatment, Procedure, Cost and Side Effects

What is the treatment?

Postherpetic neuralgia is basically a complication of shingles. This condition is caused by chicken pox and the risk of getting it increases as you age, especially after you hit your sixties. The condition causes a rash on the skin which comes with burning and itching sensations. These sensations tend to remain even after the rash disappears, making this condition quite frustrating for those who are suffering from it. Unfortunately, there is no cure for this condition. The treatment methods mainly focus on making the condition more bearable for the patients.

Although there is no cure, there are a variety of treatment options available. While no single treatment can help with the condition, it is usually a combination of different treatment types that end up relieving the pain. Doctors most commonly prescribe lidocaine skin patches, capsaicin patches, anti-convulsions, anti-depressants, opiod painkillers, steroids, and occasionally some pain medications that are available over the counter to help with the symptoms. Since there isn’t one specific treatment type that helps, finding the perfect combination to get rid of the symptoms can take a while. This can be very disheartening for patients who are suffering from extreme burning and itching sensations and can even hamper their daily tasks. However, it is important to note that eventually one does come across the correct medication and it can go a long way in pain management.

How is the treatment done?

Oncepostherpetic neuralgia is diagnosed, the treatment can begin. Lidocain skin patches are meant to be used topically on the areas where the infection shows itself. These patches eradicate pain. Capsaicin skin patches are patches that are made of chilli. Though that may sound counterintuitive (rubbing chillies on wounds never sounds like a good idea), these patches help a lot when it comes to relieving pain topically. Unlike the lidocaine patch, these patches cannot be applied at home and can only be applied by someone who is trained to use them. The infected area is numbed before the application, which is why the chillies don’t hurt you.

Anti-convulsion medications are also known to work. Since postherpetic neuralgia is a condition that affects the nerve endings, leading to the rash and itching and burning sensations, the medication can help stabilize abnormal activities in the nerves. Anti-depressants, on the other hand, are prescribed to alter the way your body perceives the pain it feels. It is not just used for people who are depressed. Anti-depressants are prescribed in dosages that are small and manageable so that they don’t play havoc on your mood and emotions.

For some people, the pain can be more intense than others and over the counter medications do not really help too much. If this is the case, your doctor will end up prescribing opiod painkillers to you. These painkillers are extremely strong and can help numb out almost any pain. They may help you manage your pain very well and can even help you lead a normal life.

Who is eligible for the treatment? (When is the treatment done?)

If you have been diagnosed with postherpetic neuralgia, then you are eligible to try out any of these treatments, per your doctors recommendations.

Who is not eligible for the treatment?

Anyone who is not diagnosed with postherpetic neuralgia is not eligible to try out any of these treatments. If you just have chicken pox, you cannot use these treatments.

Are there any side effects?

Many of the medications that can be prescribed to help manage postherpetic neuralgia can have certain side effects. If you have been prescribed anti-convulsion medication, then you can expect drowsiness, swelling in the feet, unclear thinking, and unsteadiness. Similarly, anti-depressants can also lead to drowsiness, changes in your mood, dry mouth, weight gain, or even light-headedness. As to be expected, it is the opiod painkillers that come with the most amount of side effects to be vary of. These painkillers can make you feel extremely drowsy. They can even cause some dizziness, constipation, and confusion. Opiod painkillers are also addictive in nature.

What are the post-treatment guidelines?

The treatment of this condition never truly ends as there is no cure for it. Thus all guidelines given to you by your doctor regarding pain management apply to the rest of your life. Since you will be on so many medications, you may have to watch your diet or bring about certain changes in your lifestyle like avoiding alcohol, operating heavy machinery, and even driving.

How long does it take to recover?

The condition lasts for a lifetime, which is why there is no recovery period. However, there are periods in which you will not feel any pain, depending on the pain medication that you are on. For instance, capsaicin patches can lead to pain relief for up to three months in total while opiod painkillers can lead to pain relief for as long as you take the medication.

What is the price of the treatment in India?

Most painkillers in India cost anywhere between Rs. 50 and Rs. 200, depending on the make and dosage of the product.

Are the results of the treatment permanent?

Since there is no permanent cure of this condition, the pain relief that you may feel will also not be permanent. It will last as long as you take your medication.

What are the alternatives to the treatment?

There are no specific home remedies to dealing with this condition. However, you can try using anaesthetic creams topically as and when you require them. You can also try hot and cold compresses to relieve some of the pain. Soaking in a hot bath with an anti-inflammatory essential oil such as lavender essential oil can also help with some of the symptoms like itching, though not necessarily with the burning. Wearing sock gloves on your hands while you sleep to prevent scratching yourself can also help with pain as you may break the skin while scratching intensely. Finally, you can also try massages to soothe your skin and acupuncture as well, though they can only provide a little bit of relief. Sticking to the treatment plan outlined by your doctor can help you the most.

Safety: Medium Effectiveness: Low Timeliness: Low Relative Risk: Low Side Effects: Low Time For Recovery: Low Price Range: Rs. 50 - Rs. 200

Popular Health Tips

Post-Herpetic Neuralgia Chronic Pain Management!

MD,DNB, MBBS Bachelor of Medicine and Bachelor of Surgery, Fellowship In Pain Management
Pain Management Specialist, Mumbai
Post-Herpetic Neuralgia Chronic Pain Management!

The condition of persistent pain in the body, where an outbreak of the Varicella Zoster virus has caused Shingles, is termed as post-herpetic neuralgia. It is a debilitating complication of the herpes zoster virus. The blisters that occur in shingles develop a crust formation and neuralgia begins after these crusts are formed. It may also occur in people who do not produce the crustaceous lesions. A burning pain that is long-lasting, even after the rash and the blisters disappear, is observed. There is a criteria of the pain to be persistent for around three months for the confirmation of post herpetic neuralgia.

The cause of this condition is damage of the sensory nerves that can occur due to the movement of the reactivated Herpes Zoster virus from the nerves to the skin. In an individual affected with chickenpox, the infection can involve dorsal root ganglia, where the virus lies dormant. Under conditions like stress due to infection or in an immuno-compromised individual, after a period of time, reactivation of the virus takes place. This reactivation causes production of Shingles on the body. The dormant virus reaches the skin and reactivates to produce lesions.

With an increase in age, the chances of developing post-herpetic neuralgia also increase. It primarily affects older individuals in the age group of 60 to 70 years. Treatment is aimed at pain management and providing symptomatic relief, with improvement of the neuralgia over a period of time. Symptoms of this condition are limited to the area of shingles’ outbreak. Trunk is commonly affected on a unilateral site. It can also occur on face. Common symptoms include pain lasting 3 months or longer after healing of the shingles rash, allodynia, numbness over the affected area and itching. Even a slight touch of cloth over the affected area can cause alleviated pain to the individual. Disturbed sleep and development of clinical depression is usually associated with post herpetic neuralgia. The medications given for post herpetic neuralgia are aimed at pain relief and resolving of symptoms. Management of chronic pain can be brought about by the use of a combination of pain relieving drug classes.

Some commonly used drugs for treatment of post-herpetic neuralgia are as follows:

  1. Topical Agents: Numerous topical agents have been effectively used in the treatment of post-herpetic neuralgia. In patients with allodynia or an alleviated pain sensation, topical lidocaine patches are very effective. The nociceptive activity of small nerve fibers is decreased by use of Lidocaine. Also, the brush of clothing is avoided by the patch serving as a protective barrier itself. Another topical agent that has proved effective in pain relief is Capsaicin. Its clinical use is limited due to the burning sensation caused by its application. With regular use, however, the burning sensation gradually reduces. Capsaicin should be used for a minimum period of a month to aid pain relief. Low systemic absorption of the topical agents ensure few side effects caused by them.
  2. Antidepressants: The standard drug therapy for treatment of post-herpetic neuralgia include the use of antidepressant drugs. Drugs like Nortriptyline, Amitriptyline are the most commonly used drugs amongst the tricyclic antidepressants for pain relief in post-herpetic neuralgia. These drugs are however associated with various adverse effects like sedation and cardiac dysrhythmias. Other drug classes like Serotonin reuptake inhibitors are used in individuals with low tolerance to the tricyclic antidepressants. Depression symptoms are relieved by the use of this drug class. Specific relief of the chronic pain of post-herpetic neuralgia is not achieved much efficiently though.
  3. Anticonvulsants: Neuropathic pain can be relieved by many anticonvulsant drugs. Drugs like Pregabalin have lesser side effects and also require a lesser monitoring than previously used anticonvulsant drugs like Carbamazepine.
  4. Opioids: Long term use of opioids shows significant risks like sedation and mental clouding. These drugs are considered safe for use without causing cardiac or hepatic adverse effects. When opioids are prescribed, stool softeners and laxatives should also be given to avoid constipation. Other pain management protocol includes cryotherapy, ablation of the affected roots of nerve, anterolateral cordotomy and even the use of electrical nerve stimulation. The physician should evaluate the best suitable pain management option and provide treatment accordingly.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4233 people found this helpful

Radiofrequency Ablation For Trigeminal Neuralgia!

MD,DNB, MBBS Bachelor of Medicine and Bachelor of Surgery, Fellowship In Pain Management
Pain Management Specialist, Mumbai

Trigeminal Neuralgia is a type of chronic pain disorder, which affects the trigeminal nerve. There are mainly two types:

Typical Trigeminal Neuralgia and Atypical Trigeminal Neuralgia.

The typical form or this disorder results in certain episodes of severe, sudden, shock-like pain in one side of the face, which lasts for seconds to few minutes.

Symptoms

Trigeminal Neuralgia may have symptoms which include one or more of patterns like the following:

  • Some episodes of severe,
  • Shooting pain which may seem like an electric shock.

A person might come across spontaneous attacks of pain or even attacks which might get triggered by certain things like touching the face, chewing, speaking or even while brushing the teeth.

Causes

When trigeminal neuralgia occurs, the trigeminal nerve’s function gets disrupted. The problem occurs through a contact between an artery or a vein and the trigeminal nerve at the base of one’s brain. This contact puts pressure on the nerve, thus causing it to malfunction.

Trigeminal Neuralgia can occur due to people getting aged or due to any kind of disorder that causes damage to the myelin sheath that protects certain nerves. A number of triggers can lead to the pain of trigeminal neuralgia, which include:

  • While shaving
  • When someone touches one’s face.
  • When a person is eating something.
  • While brushing teeth
  • Smiling
  • Washing one’s face.

What Is Radiofrequency Ablation for Trigeminal Neuralgia?

Radiofrequency Ablation or RFA is a technique by way of surgery, which helps to direct high-frequency heat on to the targeted areas of the body, such as tumors and tissues. When a person suffers chronic pain that means the high-frequency heat is getting targeted to the nerves.

A person suffering from trigeminal neuralgia, would have his or her doctor, who is a neurosurgeon, uses radiofrequency ablation to hit the trigeminal nerve, thereby destroying the nerve’s ability to get the pain signals transmitted to one’s brain.

Medication is the first line of treatment for trigeminal neuralgia by a neurosurgeon, to see how the patient reacts. If that person suffers from severe pain in the face and does not show any improvement through medication, then the doctor might recommend him/her to go for radiofrequency ablation surgery.

How Is The Procedure Conducted?

During the radiofrequency ablation for trigeminal neuralgia, people remain awake and asleep at different times. The process includes:

When the patient is asleep under the influence of general anaesthesia, a neurosurgeon would carefully place a needle through the corner of one’s mouth in order to reach the trigeminal nerve, which lies at the base of the skull. Then, once the X-rays confirm the needle is right in place, the neurosurgeon would wake the patient up, stimulate the nerve and ask the patient if he or she could feel the stimulation exactly at the place where the pain is experienced. This particular step confirms that the doctor has hit the right location. Once, the patient gets back to sleep, the doctor uses radiofrequency heat to minimally injure the nerve, sufficiently enough to induce a numb feeling on the face along with tingling, thus take the pain away.

4362 people found this helpful

Trigeminal Neuralgia - Understanding the Treatment Options!

MD, FIPM, CCEPC, Fellowship In Pain Management
Pain Management Specialist, Jaipur
Trigeminal Neuralgia - Understanding the Treatment Options!

Trigeminal neuralgia can be best described as an ongoing condition that affects a group of nerves called the fifth cranial nerve which is responsible for sensation in the face. Individuals suffering from this pain say that the pain feels like that of an electric shock and sometimes it becomes unbearably severe. According to medical experts, the trigeminal neuralgia is the acutest pain that an individual can suffer from where the pain mostly affects the lower portion of the face along with the jaw and may also affect the lips, nose, ears and eyes. Trigeminal neuralgia is thought to affect over 1 million people across the world and 1 person in every 15,000 people suffers from this disease.

Understanding the causes of trigeminal neuralgia
The human face comprises of two trigeminal nerves, one on each side of the face and each splits into 3 branches which aid in transmitting sensations of pain as well as a touch from the teeth, mouth, and face to the brain. Most cases of trigeminal neuralgia are said to be triggered by the blood vessels, which sometimes presses the root of the trigeminal nerve. This is known to make the nerve transmit signals which lead to the feeling of stabbing and throbbing pain in the facial regions.

The exertion of pressure on the nerves is mostly caused by multiple sclerosis and tumor and some other suspected causes of trigeminal neuralgia include, pressing of the blood vessel against the root of the trigeminal nerve, demyelization of the trigeminal nerves during the advanced stages of multiple sclerosis, physical damage to the nerve caused by an injury, a surgical procedure or a severe infection, although rare, pressing of a tumor against the trigeminal nerve may also cause it and family history and genetic conditions are also responsible for causing trigeminal neuralgia

Diagnosing trigeminal neuralgia:
If the primary health care provider feels that the symptoms of facial pain are indicative of trigeminal neuralgia, then the patient’s face is required to be examined and evaluated more carefully to detect the affected parts with precision. Other conditions which may have similar symptoms including tooth problems and sinusitis would be eliminated first. Then an MRI scan would be performed which would help understand whether the trigeminal neuralgia is triggered by some underlying medical issues. But the MRI would not be able to reveal the reasons behind the irritation of the nerve unless tumor or multiple sclerosis is the cause. This is because it is not possible to visualize the blood vessel that stands next to the nerve root.

Getting the right treatment for trigeminal neuralgia:

  1. Interventional Treatments: 
    • Percutaneous Radiofrequency(RF) Ablation of Gasserian Ganglion 
    • Percutaneous Glycerol Rhizolysis 
    • Percutaneous Baloon Micro compression 
  2. Surgical Microvascular Decompression (MVD) 
  3. Gamma Knife Stereotactic Radiation Therapy

If you wish to discuss any specific problem, you can consult a pain management specialist.

3796 people found this helpful

Home Remedies Trigeminal Neuralgia By Niramay Ayurveda

Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Ayurveda, Ph.d Arthritic Disorder
Ayurveda, Surat
Home Remedies Trigeminal Neuralgia By Niramay Ayurveda

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

Home Remedies

Fried Methi (Fenugreek)                 100gm

Haldi (Turmeric)                               100gm

Ganthoda (Granthik)                       10gm

___________________________

Mix it properly

Dose: one tea Spoon Morning & Evening

Castrol oil – one tea spoon with warm water/ milk /tea at bed time once or twice in weak

Fried Lahsun- with ghee and take one two prices every day morning.

Fried Methi (Fenugreek)                 100gm

Sunthi-                                             100gm

Gud (Jagarry)                                   50gm

Ghee                                                 30gm

____________________________

Mix it properly and take two tea spoons early morning.

General Skin Care

MBBS, MD - Dermatology , Venereology & Leprosy
Dermatologist, Chennai
General Skin Care
1. Daily cleansing of skin should be done, but avoid regular use of antimicrobial soaps.

2. Skin folds or creases (groin, underarms, abdominal folds) need to be kept clean and dry. Increased moisture and warmth in these areas may act as a good environment for microbial proliferation.

3. Wear cotton clothes in summers. One should preferably use a footwear with good aeration if frequently getting foot infections or use powder prior to wearing shocks and try to remove shoes and provide aeration to feet during recces time.

4. Skin rashes can not only be due to infections, but also be caused by allergy to footwear, cosmetics, tapes, soaps, fabrics, color leaching out of fabric, jeans buttons or sometimes due to irritant dermatitis on coming in contact with irritants like certain highly concentrated disinfectants, etc whole body rashes could result from food or drug allergies or viral exanthem (viral fevers). Consult a dermatologist to ascertain the type of rash and take proper treatment. Avoid self medication as it may complicate your condition. E. G. A rash of hepres zoster may be mistakenly treated by self medication and when it does not respond one reaches the doctor late when actually the treatment should have better results when started within 72 hours, and best if started within 24 hours. The risk of postherpetic neuralgia that is pain persisting after treatment for herpes zoster skin rash is higher when treatment not started early.

5. Use moisturizing creams or ointments for dry skin. Avoid alcohol based products over dry skin as it will cause further dryness.

6. For people with urinary and stool incontinence- use good diaper and change them frequently. Change diapers immediatley on soiling with stool. Urine and stools can irritate the skin and damage the skin barrier and cause breakdown of skin- red rashes, raw areas.

7. Avoid frequent use of excessive talc powders as they can" cake up" and keep moisture in and thus promote microbial growth in folds especially over neck fold of small children.

8. Use proper fitting footwear with soft soles to avoid hardening of skin at pressure points. Regularly use moisturizer over feet at bedtime to keep the feet soft and supple. Weekly soaking the feet in lukewarm water for 20 min and pat dry and apply moisturizer at night would keep feet softer. For diabetics if they have neuropathy use plain tap water or lukewarm water should be checked by someone else to ascertain the water temperature is just warm.

9. In old people with thick nails, its easier to cut the nails after soaking in water for 30 minutes.
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Popular Questions & Answers

My wife contracted Herpes zoster while at hospital. She was treated by Acivir tablets and cream. Now after one month all the Herpes lesions have gone and dried up leaving marks on the skin. She is complaining of severe pain at the site. How to relieve her of this pain?

C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
YOur wife has postherpetic neuralgia and it is very common with herpes infection and she needs acyclovir like antiviral again
1 person found this helpful

Is bagantin 300 can be taken by prostate enlargement patients will it affect urinary flow.

C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
Gabantin 300 MG Capsule cannot be taken for prostate enlargement and it is an anticonvulsant which is used in the treatment of epilepsy and postherpetic neuralgia.

I many time have pain in left back of my head and inflammation in gums an teeth and sometime pain in ears went to dentist opg were done thrice no problem doctor said its trigeminal neuralgia went to ent no problem diagnosed refer to neurons for neuralgia what is this is this brain tumor or neuralgia have deficiency of vitamin d.

BDS, MDS - Oral & Maxillofacial Surgery, Advanced course in maxillofacial sugery
Dentist, Lucknow
Neuralgia is a nerve pain what you describe appears to b a migraine send reports and xray on line what other details you can give to understand it better neuralgia is not a brain tumor.

I have trigeminal neuralgia. Have osteoporosis (T Score -3). Sytica and Knee pain. Please advise me for treatment.

BPTh/BPT
Physiotherapist, Kolkata
Do not sit on floor stop it totally use choamate IFT on lumbar spine pain area and sciatica notch area and lateral side of upper end of femur 15 min x 15 days minimum knee pain IFT 15 minx 12 days use good quality ls spine brace Ice compress.

Suffering from Trigeminal Neuralgia since 6 months and am on Oxetol 300 mg*2. Please advice. Also if this can be due to RCT done?

MPTh/MPT
Physiotherapist, Indore
Hello lybrate-user, for trigeminal neuralgia stem cell has been found effective in some cases. If you have any reports with you and you willing to opt this as an alternative treatment please let me know. Regards.
2 people found this helpful

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
Play video
Medications To Treat Pain
Hi,

I am Doctor Varun Singla International pain specialist doctor of reviving pain and spine centre. So today we will discuss about medicine. What is pain medicine? Who is a pain specialist? Then we'll go to the conditions which are being treated by page creation and you can help the people in the treatment of these conditions. Medicine which deals with the management of pain and who is a pain specialist doctor who specialises in pain in the use of minimally invasive non-surgical procedures.

So I see many patients who are coming to us and they are suffering from pain living with it and don t take treatment and unaware of the treatment that are available today in the modern medicine so many ways by which you can be treated by open position for example back pain, sciatica pain, joint pain, shoulder pain, Trigeminal Neuralgia facial pain many things in which you can see treatment. There are many ways to get rid of pain like physiotherapy, chiropractors, massage, manipulation surgery and minimally invasive procedures. In our houses, if someone has pain how do they go about it. They start with home based therapies, massages and then they will go to the chemist to buy a medicine a painkiller that is a dangerous thing.

That is not to be done and if the pain is not relieved they will go to the doctor like the orthopedician or a surgeon then their device do surgery. And many people will face now that should I go for a surgery? Has there a risk involved but they are not being cheated with medicine or physiotherapy. What to do? Here comes the role of interventional pain medicine which is a non surgical minimally invasive and leaving procedures so they can go for these procedures.

So how does a pain physician relieve the pain? What are the methods by which a pain physician relieves the pain? These are like injecting drugs to a target area under imaging like laparoscopy or ultrasound small needle like injection and second thing is radiofrequency ablation. 3rd Thing would be intrathecal pump spinal cord stimulator and then there is endoscopic spine surgery. It is a spine endoscopy so when should you visit the pain physician if you are having any chronic pain which is more than 3 months like back pain, sciatica neck, pain facial pain, trigonal Neuralgia, joint pains, poster camera neuralgias, shoulder pain, knee pain, crps for any of these Sonic Paints so you can visit to pain specialist who can get rid of your pain if you are suffering from any kind of chronic pain. Kindly visit the wine pain and spine centre thank you
Play video
Chronic Pain
Symptoms and Treatment for Chronic Pain

Hi. I am Dr. Shantanu Mullick from Navi Mumbai, Pain Clear Clinic. Today, the whole world is suffering from chronic pain.

Million patients they are suffering from different types of chronic pain like back pain, neck pain and cervical spondylosis. Mainly, due to their lifestyle disorders but they are also suffering from different complicated pains like cancer pain, but most of the patients they are suffering from chronic pain with frozen shoulder, knee pain, back pain. They are going for surgery but many times these surgeries may not help in that way. That is why this newer therapy, intreventional pain therapy which is nowadays throughout the world and very much effective to support this kind of chronic pain to rule out the disease as well as to treat the level of the root cause.

Normally, the patients who are suffering from the back pain, many times I have seen that after regular therapy , physiotherapy, exercise, they are not getting relief and they are going for the surgery. In those cases, interventional pain therapy will help the to rule out the cause. We do treat these patients according to MRI reports but all these treatments are done without surgery. So many times, surgery may not help these kind of back pains and in cervical pains. So in those pains, interventional pain therapy, without damaging the anatomy helps a lot. So if you see the pain where we can see the patient is suffering from disc pain. We can see here the nerve root coming there and the disc is bulge and we commonly call it as slip disc problem or disc hernation. In those cases, the surgeons are getting the bones, there is a lamenectomy but without doing surgery as per MRI report we are under forescopic guidance in the operation theatre we are going inside the disc and treating them without any surgery and day care.

So patients automatically get very good relief and after that we are able to support the patients with physiotherapy exercises and this way we can help different types of patients suffering with back pain, neck pain. On the other hand, in case of cancer pain also when the patients are not getting relief with the morphine or from very strong pain killers, we can support them with interventional pain therapy to block their pains permanently working in the spinal cord.

Another, dreadful pain condition is trigeminal neuralgia where patient is suffering from pain in the face usually the pain comes where patients complain of sharp shooting, electric shock kind of pain. It will appear on one side of the face. Actually the trigeminal nerve is coming from the brain and it is supplying the nerves of the face in three ways. Usually it happens in one side and those patients initially are treated with medical therapy and any times they are not getting support in those cases we are treating with radiofrequency ablation therapy. So different types of new treatments have for this chronic pain where patients without knowing their disease, they keep on taking pain killers and damaging their other organs of the body so that is why pain management nowadays is a very very effective subject and separate speciality to support the chronic pains those who are suffering from long types of disease.

At last, I want to say if you want to more about this, contact us through lybrate.com.


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