Treatment Modalities in Chronic Pain Treatment In Delhi

Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.

Acute pain is the pain that is present after an injury until healing occurs. Pain in this situation is a protective response bringing our attention to the affected area and helping us protect, rest the affected tissue providing an opportunity for healing. As the tissue heals, the pain gradually abates.

Chronic or persisting pain is pain that persists even after the usual time required for healing. It is important to understand that chronic pain does not always signify on-going damage. Nerves have a memory (plasticity in medical terms) whereby they develop changes that remain even after the original inciting problem is corrected. A simple example to explain this is persisting leg pain even after the amputation of the affected part. There are numerous mechanisms to explain this and your doctor can help you understand these better.

The impact of chronic pain is not limited to the involved person but also affects their loved ones and family members. The longer it persists the more chances that it will have an impact on multiple aspects of your life including your ability to work, sleeping pattern, mood, social life, relationship with family and friends, etc. Hence it is important to take corrective measures to reverse or control the condition as soon as possible.

The management varies depending on the actual pathology, severity, comorbidities, patient preferences, available resources/ expertise, and many other factors. At your first consultation with me, you can expect a detailed assessment including history, examination, and review of investigations. This is aimed at identifying the underlying reason for pain so that an appropriate personalized management plan can be made. Some more tests may be requested as necessary. Close liaison with specialists in other fields such as neurology and surgery is maintained to formulate the best plan tailored to your condition and requirements. Some of the common pain treatment modalities include:

Medical management

I normally review your current medications and any existing medical problems prior to suggesting new medications or changes to current medications. Therefore it is a good idea to carry a detailed list of your medications and make of list of the ones you may have tried previously. Doses of medications tried previously are equally important as some medications if not used in the right doses for the required duration are unlikely to be effective.

Different types of pain may need treatment with different medications, for example pain of inflammatory origin maybe be effectively managed with anti-inflammatory medication and pain due to irritation of nerve may need medication which helps to desensitize the nerves. Hence the importance of identifying the likely pain generators prior to prescribing medications.

Interventional procedures

In certain situations, I suggest procedures such as

• Injections/ radiofrequency procedures that help to reduce the pain signals being transmitted by the nerves to your brain
• Injections directly into a joint space/ around the area of problem such as a tendon or bursa which can help reduce the inflammation more effectively than medications taken orally. These procedures along with being therapeutic may also help the consultant confirm the diagnosis

Regenerative medicine has opened new avenues where cells from your body are used to promote healing and reduce pain. Awareness of options such as Platelet-Rich Plasma (PRP) and stem cells is increasing and new research in this area is improving our understanding day by day.

Some interventional procedures can be done in the outpatient setting, whereas others will require a day case admission. This depends on the procedure being performed and your general health, other medical problems. We aim to reduce your pain as much as possible by offering you most appropriate interventions keeping your goals and preferences in mind and with an integrated multi-specialty team approach based on the biopsychosocial model of pain you have the best chances of managing your pain.

Role of Physiotherapy

There are few common elements in management of most chronic pain situations like weakness accompanied by disuse of affected part for long time will require gradual mobilization and strengthening. A good chronic pain physiotherapist offers more than physiotherapy. They play an important role in

• Patient education regarding their condition, do’s and don’ts specific to their condition,
• Setting realistic goals-dividing exercises into smaller achievable steps
• Help patients understand and implement pacing of activities
• Promoting compliance, increasing confidence and making you self reliant
• Challenging your unhelpful thoughts, mitigating any false believes and minimising catastrophisation

Role of Psychology

Chronic pain can generate significant distress, anxiety and depression and all these, in turn, can magnify perceived pain. This is a normal human reaction which is often more visible to friends and family. Addressing these factors can help in reducing perceived pain and in improving quality of life. Psychologists can help you by challenging maladaptive beliefs, attitudes and emotions. They can help by

• Teaching coping and self-help strategies
• Relaxation techniques- these can be a useful tool especially in dealing with sleep disturbances and periods of increased pain
• Cognitive Behavioural Therapy (CBT)

Migraine and Headache Specialist and Doctors In Delhi

Headaches are a common health issue that affects people of all ages world over

Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc. Headaches which keep recurring are called recurrent headaches and those that tend to persist for a long period of time are called chronic headaches.

Headaches can hinder day to day activities and severely affect the quality of life especially in individuals who experience frequent severe headaches or long lasting / constant headaches . Recurrent headaches can be quite difficult to handle since they tend to develop suddenly, not giving you an opportunity to prepare for it and plan your day. There a variety of measures that you can take in order to reduce the impact and frequency of these headaches. Some of these are quite simple, but most people doubt the effectiveness and hence are hesitant to implement. These can work synergistically with the other management options suggested by your pain specialist. These include

General lifestyle modifications

• Regulating your sleep cycle: Having a regular sleep cycle goes a long way in helping to reduce these headaches. Good sleep environment plays an important role and includes a darkened bedroom, a quiet place where you are comfortable and it helps to unwind. Some find a relaxing hot bath helpful in unwinding prior to heading off to bed. It is advised to avoid watching TV, using laptops or mobiles before you go to bed.
• Hydration: Keep yourself well hydrated, because dehydration is a known trigger of headaches, and can worsen preexisting headaches.
• Regular meals: Have you meals on time. This another important factor that plays a role in the development of headaches. Low blood sugar/ hypoglycemia can trigger headaches. If you are in the habit of skipping meals or eating late and heavy meals, then you should consider changing this.
• Avoiding triggers: Other trigger/ precipitating factors may vary from individual to individual. From particular foods to the brightness of TV screens to loud noises, certain smells etc there are numerous factors. You are the best person to identify these and avoid them as much as possible.
• Tea and coffee: Minimize your intake of coffee and tea, because they are known to precipitate headaches. Avoid taking them late in the evenings and just before going to bed.
• Quit smoking
• Stress management and relaxation: Learn how to manage your stress in a productive manner and practice relaxation techniques.

These general measures, when used in combination with advice from your pain specialist can help you control your headaches better. Some of the common medical interventions used in management of headaches include:

Medications:

Medications for headache can be used to terminate the headache at the time you are experiencing it or can be taken as a preventive measure to reduce your chances of developing a headache. Preventive medications are usually taken when people experience frequent or continuous headaches, and they should be taken as prescribed by your doctor. Too much of any medication can also end up being the cause of your headache as well, and is given the name Medication Overuse Headache. The different medicines used for recurrent headaches are:

• Antidepressants: These medications, besides the pain relieving effects can also have other beneficial effects like reducing anxiety and sleep disturbances. The drug selected will depend on your individual situation.
• Beta blockers: Beta blockers, commonly used in management of high blood pressure and heart problems. They are helpful in the management of migraine related headaches
• Anti-seizure medicines: Several anti-seizure medicines help in the prevention different types of recurrent/ chronic headaches including migraine.
• NSAIDs: Nonsteroidal anti-inflammatory drugs are commonly used over the counter medications for mild to moderate pain, and they are effective in various different types of headaches. On frequent usage they can have harmful side effects such as gastritis and peptic ulcer disease; therefore they must be used with caution and under medical supervision.

Other interventional methods:

When simple measures such as lifestyle modifications and oral medications are not successful in resolving the headaches, then it may be worth considering other interventional methods. The intervention used will depend on the diagnosis. The common interventions include:

• Nerve blocks
• Injections of the cervical spine
• Radiofrequency treatment
• Botulinum toxin injections

Complementary & Alternative therapies

These include:

• Acupuncture – which involves the insertion of thin needles at definitive points in your body, with the intention of providing pain relief
• Massage therapy – this can help to reduce the stress and tension. It helps to relax the tightened muscles and thereby provides relief.
• Meditation and relaxation therapy
• Herbs and nutrients – Several organic herbs help in preventing migraine headaches and reduce the intensity of headaches. In deficiency states vitamin and mineral supplements can be taken to reduce headaches and prevent them from reoccurring.

It is best to seek medical advice before you starting with any of the above methods.

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How To Communicate Regarding Your Joint Pain To Your Pain Specialist In Delhi

Joint pain can be a source of prolonged discomfort which one may have to endure in life. This can affect your daily activities and make you feel depressed. Joint pain specialists in Delhi NCR are daily visited by numerous patients complaining of severe pain and in search of treatments which can provide quick relief.

For you to get the most appropriate treatment, the way you explain your pain to the doctor is important. There are a plethora of options for joint pain treatment in Delhi NCR . But reaching out to the right centre with experienced and skillful professionals whom you can count upon is important.

Read below to understand the importance of accurately describing your joint pain concerns to your treating doctor:

• Joint pain is subjective, without your explaining it may be very difficult for the doctor to know what your pain feels like and how severe it is
• Joint pain can have numerous causes such as like age related wear and tear, injury, trauma, infections etc
• Involvement of multiple joint in the body may require different assessment/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology
• Treatments offered depend on the severity of symptoms, their impact on your life, your age, activity levels and your goals/expectations. There are many treatment alternatives –both non-surgical and surgical, depending on the assessment of the above factors
• These are some important points which may help your doctor to understand and treat your pain better:

• Explain where the pain is; how long you have had the pain and how it started. If possible point the exact place, is it in the knee, ankle or shoulder pain?
• The character of pain can help in narrowing down the possible causes. For example is it aching, burning, shouting or stabbing pain? Is it present all the time?
• Aggravating or reliving factors are equally important- Is it worse when you are walking or at night time when you are trying to sleep. is it when you sit, walk or stand?
• It is important to tell the doctor how the pain affects your daily life. This information is essential as it enables the doctor to have a clear overview of what you are feeling. While describing the impact of pain do not forget about your sleep and mood.

In case the pain is short-term, your doctor may recommend home care like –

• Applying ice or hot compression at the joint several times.
• Avoiding activity that may cause the pain.
• Using a brace to protect the joint.

Various other options are used for Joint pain treatment in Delhi NCR like steroid or hyaluronic acid injections, nerve blocks and radiofrequency treatment. They can all help to ease the suffering and improve your quality of living. Some options are specific to the joints involved. These are mostly combined with medications and physiotherapy to improve outcomes.


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Tailbone Pain Or Coccydynia Pain Treatment In Delhi

What is tailbone pain?

Tailbone pain or coccydynia is pain at the lower most aspect of the backbone called the coccyx. Coccyx is positioned at the very bottom of your spine, near the buttocks and is formed of 3 to 5 of fused bony segments. Its structure including length, angle of the curve and degree of mobility varies significantly between individuals. It was once believed to be remnant of the lost tail with no relevant function. Now we understand that it provides support for sitting and a place for attachment for various muscles, tendons, and ligaments.

What causes tailbone pain?

Trauma and falls are the most frequent cause of coccydynia. Trauma can lead to break, dislocation, subluxation or bruising of the coccyx and the surrounding area. Minor repeated trauma such as during prolonged periods of sitting on hard surfaces might often go unrecognized. Spasm of the pelvic floor muscles can pull on the coccyx and lead to pain. Rare causes of coccydynia include cancers and infection. Sometimes coccyx pain is referred from the spine.
Coccydynia is four or five times more common in women. Anatomical changes in the shape of pelvis, coccyx and childbirth may account for this. Some studies have found that it is more common in obese individuals.

Signs and symptoms of tail bone damage:

Most patients present with a dull ache, which changes to a sharp or throbbing pain with activities such as getting up from a sitting position or prolonged sitting. With time the severity and duration of pain can increase. Activities such as sexual intercourse and opening of bowels may become painful. The pain can radiate towards spine, legs and affect day-to-day activities.

When should I see doctor?

Tailbone pain is can be self-limiting and resolve on its own within few weeks to months. Those with moderate to severe pain interfering with daily activities and adversely affecting the quality of life should seek medical advice sooner. Other common reasons for medical consultation include – persisting pain despite conservative management, uncertain diagnosis, associated symptoms such as signs of infection or swelling etc.
The pain physician will take a complete history, and do an examination to narrow the possibilities. You may be asked to undergo investigations such as X-ray, CT or MRI scan to confirm diagnosis and rule out other conditions with similar presentation.

How is this condition managed?

There is variety of treatment options ranging from lifestyle modifications/ conservative management to injections. Simple measures that can help include

• Find an experienced pain physician/ doctor who can help you to confirm the diagnosis and treat the condition
• Avoid prolonged sitting especially on hard surfaces and bumpy rides as while travelling on in a car/ bus
• Modify your sitting posture to reduce pressure on coccyx such as leaning towards one side or leaning forwards while sitting. One should be careful with this as it can often place extra pressure on other areas leading to new pain symptoms.
• Using a doughnut-shaped or wedge (V-shaped) cushion while sitting
• When getting up from the sitting position do so slowly
• Avoiding aggravating factors such as constipation
• Appling heat or ice to the affected area
• Simple over-the-counter pain relievers
• Physical therapy. Aimed at pelvic floor relaxation techniques, postural retraining and stretching exercises

For severe or persisting pain the pain specialist may consider

• Medication. Stronger pain relief medications
• Injections. These are used to break the pain cycle and involve placement of local anaesthetic and steroids near the pain generator. Commonly performed injections include
• Injection of joint or ligaments surrounding the sacrum and coccyx such as the sacrococcygeal joint
• Ganglion Impar nerve block. Nerve blocks help to interrupt a nerve’s ability to transmit pain signals
• Manipulation. This can be used in combination with injection therapy or separately. Massaging the muscles attached to the tailbone might help in reducing pain
• Surgery. Surgical removal of coccyx is known as a coccygectomy. Because of the associated risks (infection, wound healing problems) and poor outcomes, this procedure is not commonly recommended/ used

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Cooled Radiofrequency For Knee Pain Treatment In Delhi

Why do you experience chronic knee pain?

Chronic knee pain troubles a significant number of people worldwide. It is a common problem amongst the aging population, and can indeed be very painful and debilitating, sometime even confining individuals to the bed. The most common cause of knee pain in elderly is osteoarthritis (OA), a condition where the cartilages of the knee joint have worn out due to wear and tear. This results in friction between the bones of the joint during movement which results in pain. The impact is more in overweight and obese because of the extra load on the knees. The risk of knee OA in overweight women is nearly 4 times and in overweight men is 5 times greater. It is not just the mechanical factors which promote OA in obesity but also the co-existence of disordered glucose and lipid metabolism and the highly metabolic and inflammatory environments have a significant role.

What can be done for chronic knee pain?

Initial management involves lifestyle modification, supplements, simple pain killers and physiotherapy. It is estimated that an extra Kg of weight exerts a force of nearly three to six times across the knee while walking. Thus, weight loss is an important modifiable factor in the treatment of knee OA which the affected individual can drive. Various studies have demonstrated that weight loss improves both pain and function in obese subjects with knee OA.

Local injections are considered depending on the severity of problem and other factors such as age, functional status etc. When the pain and discomfort is severe your doctor may offer you the option of undergoing a knee replacement surgery. This involves removal of the worn out part of joint, shaping the ends of the bone and placing a metal implant. This reconstruction of the knee joint allows for smooth, pain free movement for most individuals. However some, even following the rehabilitation process, continue to experience pain.

For those who are

• Not keen on the replacement surgery or
• Not fit to have one or
• Continue to have pain after knee replacement surgery

Cooled Radiofrequency is an alternative treatment. Details about this treatment can be found in the Knee pain section of the website and in old blogs.

What causes continued pain following surgery?

The causes of knee pain following replacement surgery can be located inside the joint (intra articular causes) or outside the joint (extra articular causes).

The intra articular causes include:

• Knee joint instability
• Loosening of the implant
• Infection of the bone or the joint space
• Problems related to the kneecap (patella)
• Osteolysis (loss of bone)
• Issues related to size or type of implant

It is important to rule out the extra articular causes when a patient complains of persistent knee joint pain following surgery, because they can have serious consequences if they are missed.

The extra articular causes include:

• Localized knee problems such as tendinitis and bursitis
• Pain radiating from the  nearby joints/body parts such as spine, hip and ankles
• People who have ongoing psychological illnesses will also tend to experience longer postoperative pain
• Nerve injuries/ problems

The focus of a recent research in Oxford, UK has been weather the knee replacement should be done earlier and not as a last resort. The authors suspected that long term persisting knee pain can lead to changes in the nervous system (nerves, spinal cord and brain) which can be responsible for persisting pain even if the original cause is corrected. 

Diagnosing the problem:

You doctor will go through multiple steps in order to evaluate the pain you are experiencing. This process includes, taking a detailed history of the pain, such as when what type of pain you are experiencing and when you experience it the most. Then your doctor will go on to examine the knee, which will help him/her to further narrow down on probable causes & identify problems such as stiffness, swelling, and issues with alignment of the joint.

You will be asked to undergo investigations such as, X-ray, MRI, blood tests including inflammatory markers such as CRP and ESR etc.

How to manage this condition?

Depending on the cause of your pain, you doctor may suggest a variety of treatment plans. On some occasions pain relief medication may help to control the pain, and even get rid of it completely. Physiotherapy is another option which has proven to be effective in managing pain following knee replacement surgery. Nerve blocks are sometimes offered if nerves are suspected to be the pain generator.  Cooled Radiofrequency of the nerve supplying the knee can help in reducing or resolving your pain issues.  Sometimes repeat surgery such as revision knee replacement is required If.

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Pain Management In Delhi provides Fibromyalgia Pain Treatment In Delhi

Symptoms you should know 

Fibromyalgia is a chronic condition characterized by widespread body pain.  Other common symptoms in fibromyalgia include unrefreshing sleep, tiredness/fatigue, low mood and memory problems.  It is more common in women and is commonly known as ‘fibro’ or "fibrofog". No clear pathophysiological mechanism for fibromyalgia has been established, but there is evidence that patients have abnormality pain processing with increased sensitivity to various stimuli such as pressure.
As the symptoms tend to be non-specific, and there are no specific tests which can be carried out to diagnose, fibromyalgia can be challenging to diagnose. It is important that you explain your symptoms correctly and in detail to your doctor as it can aid in establishing the diagnosis.  Fibromyalgia often occurs in patients with other conditions, such as inflammatory arthritis and osteoarthritis and is not a diagnosis of exclusion.
So, if you are experiencing longstanding constant widespread body pain, with varying distribution and the cause for the pain cannot be explained by any other abnormality detected, then it might be possible that you are suffering from fibromyalgia. The symptoms are generally managed using a range of drug and non drug mechanisms. Some of the common symptoms in fibromyalgia include:

Widespread body pain and tenderness

This is the most common reason for which patients seek medical opinion/ vsit a pain specialist doctor in delhi. This differs from other conditions such as arthritis as the pain in not localised to one area or the joints only. Muscle and joint pain is commonly seen in majority of patients. The pain may vary in severity and nature (dull ache/ heaviness/ throbbing /burning) . Most often the pain is continuous although in some it may be intermittent; some others feel like the pain keeps travelling from one area of their body to another. Patients may have areas which are tender to touch with increased sensitive to pain. Long term persisting pain can lead to inactivity which can further promote deconditioning of muscles and worsening pain. It can also lead to physically inactive maladaptive posture & gait, bursitis and tendinopathies.

Fatigue

A constant feeling of tiredness is another common symptom present in majority of fibromyalgia patients. Even after adequate periods of rest fibromyalgia patients may feel like you don’t have the energy to get through the day. Intense workouts may be a thing of the past with basic daily chores becoming an uphill task. Slowly it may start to affect other dimentions of life such as relationships, social life, work etc.

Sleep disturbances

No restorative sleep, inability to sleep and fatigue are common in fibromyalgia patients. Patients generally feel tired in the mornings. Sometimes, because of the easy fatigability, even though you fall asleep quickly the sleep may be interrupted and non refreshing. Pain and emotional disturbances may contribute to the sleep disturbances.

Mood variations

More than half the patients diagnosed with fibromyalgia, suffer from mood disturbances such as depression or anxiety disorders. And it is no surprise that people tend to feel low and worried all the time when they are experiencing pain all over their body for a long period of time. When you are having a hard time managing your day to day life, when basic functionality is like a challenge to, it’s only natural that you are going to feel a little hopeless and anxious about it. Staying active and staying connected is something that you have to make a huge effort for.

Memory problems and impaired concentration

The name fibrofog comes from the memory issues seen in fibromyalgia. Fog represent the lack of clarity or haziness. It’s a very common symptom amongst patients, where they complain of forgetting basic things like where they have left their keys, and not remembering plans they have made.

Tingling sensation in extremities

Some experience tingling sensation in their extremities especially on their toes and fingers, while some others complain of numbness. The term paresthesia is sometimes used to address these symptoms. These symptoms tend to flare up from time to time, although in some cases they can be a constant feature.

Other associated problems

Headache
It is a common problem which tends to interfere with the individuals daily life, and can be debilitating. They often develop a migraine or tension headaches from time to time. Sometimes a headache can also be due to the stiffness of the muscles in and around your neck region and upper back.
Irritable Bowel Syndrome:
There are occasions when people suffering from fibromyalgia complain of abdominal pain, have a bloated sensation in the abdomen and experience episodes of constipation or diarrhea. All of this is because of a condition known as irritable bowel syndrome. Individuals can also experience a feeling of regurgitation following meals, which is due to gastro-esophageal reflux disease, which is also associated with fibromyalgia.
Restless legs & leg cramps
Since patients having fibromyalgia, complain of a variety of symptoms as mentioned above, it is not difficult to miss the diagnosis. Therefore it is very important that you discuss your symptoms at length with an experienced doctor.

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Pain Management Centre In Delhi For Chronic Pain Treatment In Delhi

Pain is a common reason for medical consultation. Over the years, studies evaluating the Global Burden of Diseases have found chronic pain conditions amongst the leading causes of disability worldwide. The impact of chronic pain can vary, ranging from an occasional distraction or discomfort to constant severe debilitation. Some examples of common chronic pain conditions include back and neck pain, sciatica, diabetic neuropathy, headache, frozen shoulder, persisting post surgical pain, cancer pain, abdominal pain, pelvic pain and fibromyalgia. Pain in a significant proportion of these conditions is amplified by stressful and sedentary life style with obesity, lack of regular exercise, smoking, poor workplace ergonomics contributing to the increasing incidence and severity.
Chronic or longstanding pain does not always signify ongoing damage. Conditions such as arthritic knee or back pain are often accepted as part of aging process, stopping people from exploring treatment options.  It can, however, cause significant distress and compromise the quality of life. With the correct help, you can control your pain better and make your life easier. A best pain specialist doctor in delhi can help to diagnose the cause of your pain and work towards relieving/ reducing it and minimise the impact on your daily routine. This is how the approach of pain management specialists is different:

Knowledge and experience

When you receive specialist training in a subject and deal with specific conditions on a daily basis (chronic pain in this case) your experience/ learning is bound to reflect your treatments and outcomes. The education and the training received helps in successfully diagnosing and treating pain issues. In India the opportunities for specializing in Pain Medicine are limited with no nationally ascribed curriculum. In the western countries pain medicine is reorganized as a separate specialty with numerous training and super specialization opportunities. Pain clinics form an integral part of most reasonable sized, good hospitals. Pain specialists generally undertake a detailed assessment of every aspect of pain and try to address problems comprehensively.
 I have spent a year doing pain research and another year in pursuing advanced training in the field of pain medicine in London, UK. This is addition to the basic and intermediate training in pain medicine during my 7 years of initial anaesthesia training in London, UK.  Subsequently I have worked as a Chronic Pain Consultant in UK.

Treating the cause of the pain and not just the symptoms

Pain specialists try to explore why a problem may have occurred as this is important to prevent reoccurrences. Once the underlying problem has been resolved, the pain may automatically ease off giving you lasting relief. This is better approach than just taking medications for temporary relief. Understandably this may not be possible in all cases but this should not become a deterrent to trying.

Treating the body as a whole

Pain management specialists are trained to visualize body as a whole and use a multidisciplinary approach while addressing chronic pain. They don’t concentrate on just controlling the pain, as they understand that pain can affect multiple facets of life from mental health to relationships to jobs to social life etc. Each person is unique and experiences/ processes pain differently and hence the need for individually tailored therapies. They use a combination of modalities including physiotherapy, medications, injections/ interventional therapies, psychological therapies, Complementary and alternative therapies including Acupuncture, TENS, acupressure, and meditation along with patient education to achieve the best possible results.

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