Hi pspringer,
Thank you for an interesting question.
New treatments for chronic pain
http://oh.essortment.com/chronicpaintre_rvsi.htm
"This article will not really delve into the different pharmaceuticals
available to treat pain, but rather with some new innovative,
promising, but questionable treatments.
Vertebroplasty:
For people who have experienced the prolonged and debilitating pain
associated with compression fractures in their spine (usually
resulting from osteoporosis) vertebroplasty may offer them some
relief. This procedure involves injecting bone cement into the
vertebrae where the compression fracture resides. This stabilizes the
fracture thus relieving the pain.
Before undergoing the procedure the radiologist will use X-rays, bone
scans and MRIs to find the location of the fracture that is causing
the pain. After locating and isolating the particular area, the bone
cement is injected into the vertebrae using a hollow needle. The
cement hardens within fifteen minutes and the patient remains on bed
rest for a few hours.
The cost for a typical vertebroplasty is around $1,000 which is much
less than the typical expenses involving skilled nurses, home care,
loss of wages, braces, and long periods of bed rest.
A comprehensive management program for vertebral compression fractures
can be found at the Mayo Clinic and also the University of Virginia.
Therapeutic Magnets:
Therapeutic magnets are becoming a popular item in pain control,
although the jury is still out on them. Research done at Baylor
College of Medicine found that 76 percent of participants wearing the
magnets did report significant pain relief, while only 19 percent
wearing a placebo reported any pain relief.
In some circles magnets are growing in popularity as the pain
treatment of choice. It is believed that they stimulate blood and
speed the overall healing process, but neither the safety or the
efficacy of these magnets have been proven.
However, according to the Illinois Pain Treatment Institute
Newsletters, there is no conclusive evidence to show that magnets
don't work. Research is in fact showing some proof that magnets may:
1.Increase blood flow by dilating blood vessels and attracting oxygen.
Change migration of calcium ions to heal broken bones or move calcium
away from arthritic joints.
Block pain signals sent by nerves to the brain.
Alter the pH balance of bodily fluids.
Attract iron in the blood to stimulate circulation.
For more information on magnets in pain control call: Illinois Pain
Treatment Institute at 847-551-1212.
Ziconitide:
From the ocean floor emerges an exciting new substance. Ziconitide is
a manmade chemical, that is very similar to the substance a snail uses
to paralyze its prey. The chemical is said to be 100 to 1000 times
more effective in pain relief than what has been available up until
now. It has been shown to ease pain that did not respond to any other
drug treatments.
Testing is ongoing at John Hopkins Medical Institution for FDA approval.
Although these techniques are new, pain control is finally getting the
attention it deserves, and slowly new methods for pain relief are in
view! No one really understands, unless they have been in pain!"
=================================================
What's new in cancer pain treatment
http://www.cancerhelp.org.uk/help/default.asp?page=5886
"Tests in patients are called clinical trials. There are 3 phases of
clinical trials. This is fully explained in the Understanding Clinical
Trials section of CancerHelp UK. All new approaches are the subject
of ongoing research. Until studies are completed and new treatments
are found to work, these treatments cannot be used to treat cancer
pain.
There is a huge amount of research going on into different types of
cancer and treatment. There is also research into pain control,
particularly into how we feel pain and into the development of new
drugs. There is research that has identified different pain receptors
on cells. Once we know that these exist, new drugs can be developed
to block them. Researchers may have identified a different receptor
for nerve pain. This receptor doesn't respond to opioids and so
explains why nerve pain is so hard to treat with conventional
painkillers.
There is also research into how people feel pain and how it affects
your everyday life. We know that fear, depression and tiredness can
all make pain feel worse. We also know that people feel and respond
to pain in different ways and that this can make a difference in how
they respond to painkillers. We still need more research into
Different types of pain control
Side effects of the drugs
How other drugs interact with painkillers
Ways to combine alternative methods of pain control with drugs and
other treatments.
Why pain is under treated in some groups - the elderly, women,
children and ethnic minorities
Current research into pain control includes
New drugs
Radiofrequency lesioning
Vertebroplasty
Deep brain stimulation
New Drugs
There are too many drugs being researched to list them all here. This
is a selection of drugs that have recently been licensed or are the
subject of quite a bit of research.
There is information on
Fentanyl lollipops and lozenges
Capsaicin from chilli peppers
Bisphosphonates for bone pain
Methadone
Fentanyl is usually given through a patch that sticks to your skin.
It has now been licensed as a lozenge you can suck for faster pain
relief. This is called ?Oral Transmucosal Fentanyl ?(OFTC for short).
It is licensed for 'breakthrough' pain relief for people also taking
opioid painkillers.
Another fairly new painkiller comes from the red chilli pepper. It is
called capsaicin (Axsain or Zacin). It is a cream you put on your
skin to relieve tingly or burning pain, known as nerve pain. The idea
is that the burning sensation you get when you put the cream on
de-sensitises that area to pain. In other words, you feel the pain
less after the burning of the chilli! Researchers are working on a
toffee form that may help relieve the pain of mouth ulcers caused by
chemotherapy. They say the sugar in the toffee form takes the edge
off the burning from the capsaicin.
This cream is available on prescription in the UK for arthritic pain,
nerve pain called neuralgia and peripheral neuropathy, which can be a
lasting effect of some chemotherapy drugs. If you have tried other
drugs for this and they haven't helped, it may be worth discussing
with your doctor.
Bone pain and fractures can be a problem in advanced cancer.
Bisphosphonates are drugs that are used to treat these problems.
These drugs bind to areas where bone has been destroyed. This slows
down the damage caused by cancer cells.
There are a number of new bisphosphonate agents in clinical trials.
There is information about one such trial on our clinical trials
database. This trial is looking into controlling pain caused by
cancer spread to the bones in breast, prostate and lung cancer. It is
comparing the use of radiotherapy for pain control to a new
bisphosphonate drug called ibandronate. Click on the clinical trials
button to the left of your screen and search for one of these types of
cancers. Or you could do a free text search using the drug name.
Methadone is a painkiller that isn't used much these days in the UK.
It has been used to treat heroin addicts since the 1970s and this has
perhaps given it a bad name. It also stays in the body longer than
morphine and this makes it more difficult to get the dose right. But
pain specialists in the USA have found this drug is good for managing
some types of severe cancer pain, especially nerve pain. Methadone has
fewer side effects than other strong opioids. Because it does take
quite a while to get it all out of your system, it is only used for
short periods of time. If your doctor changes your pain relief over to
methadone then it is important that you are eased into this over a few
days.
Radiofrequency Lesioning
This treatment uses heat to kill nerves. A small catheter is put in
through a cut in the skin and the heat is directed straight to the
nerves. It is still under investigation and there have been mixed
results. One review found that there is some evidence it may help
with chronic neck pain but little evidence that it helped with other
types of back pain.
Vertebroplasty
If cancer spreads to the bones in the spine it often causes pain.
Cancer in the bones can make them weak and more likely to break. This
is called pathological fracture, because it is a break that has been
caused by a disease. In vertebroplasty, bone cement is injected into
damaged bones in the spine (vertebrae). The treatment eases pain and
helps to support the spine.
Deep Brain Stimulation (DBS)
This treatment has been used in certain countries for some time to
treat Parkinson?s disease. It has recently been approved in the USA
for treating Parkinson?s disease and is in clinical trials for
treating epilepsy and some types of chronic pain. This method of
treatment involves placing a device called a pacemaker in your chest
wall and connecting it to a wire that is implanted in a part of your
brain called the basal ganglia. It then delivers very small amounts of
electricity directly into nerves and specific parts of your brain. You
can control this by placing a magnet over the area of your chest where
the device has been fitted. The electricity sets off a neurological
response that disrupts the way pain is transmitted. This procedure
takes a very long time and it can be difficult to locate the exact
part of the brain where the wires need to go. This is very
experimental and we need more results from trials before we will know
how effective it is. It is a complicated treatment involving surgery
and is unlikely to ever be the first choice for treating cancer pain.
It may prove useful for some types of chronic pain that aren't
responding to simpler treatment.
=================================================
Medtronic Pain Therapies: Pain Pacemaker
http://my.webmd.com/content/article/71/81229
Jerry Lewis
http://my.webmd.com/content/article/71/81226.htm?z=3199_65247_2010_00_06
"The following article tells the story of one patient who is receiving
neurostimulation for the treatment of pain. Medtronic invited this
patient to share his story candidly. As you read it, please bear in
mind that the experiences are specific to this particular patient.
Results vary; not every response is the same."
[edit]
=================================================
Breakthrough Treatments for Chronic Diseases
New therapies target sinusitis, back pain, migraines By Janice Billingsley
HealthDay Reporter
http://www.hon.ch/News/HSN/514222.html
"Chronic disease. Even the name sounds painful.
But for suffers of several of these unrelenting health problems, life
has taken a turn for the better. From sinusitis, to lower back pain,
to migraine headaches, recent medical advances have greatly improved
patients' quality of life, although cures often remain elusive.
Chronic sinusitis, for instance, is one of the most common chronic
diseases in the United States, affecting approximately 34 million
people a year, according to the National Institute of Allergies and
Infectious Diseases. For too long, too many struggled with the
stuffiness, breathing problems, headaches and fatigue that can plague
sufferers for weeks, months -- even years."
[edit]
"Over the past 10 years there has been a steady improvement in
treatment," says Dr. Jordan Josephson, an eye, ear and nose surgeon at
New York City's Lenox Hill Hospital. "Even though you may have had
surgery and medication for sinusitis in the past, there are newer
techniques and medicines that can offer hope for significant
improvement or cure."
Adds Dr. Mary Ann Michelis, chief of allergy and immunology at
Hackensack (N.J.) University Medical Center: "A decade ago we
diagnosed sinusitis using a series of X-rays. But now we get much more
information from CT scans of paranasal sinuses. And MRIs can help
identify fungal infections."
All of which lead to better, more targeted treatments, she adds.
So do new nasal sprays, as well as intranasal nebulized antibiotics,
certain antihistamines that didn't exist 10 years ago, and topical
antifungals and antibiotics that target the specific fungi and
bacteria that often plague sinusitis sufferers, Josephson says.
For those who need surgery, newer, less-invasive treatments mean safer
operations with faster recovery times.
"Surgery used to be much more aggressive, entering through the mouth,"
Michelis says. "Now endoscopic surgery has allowed very small
surgeries to open sinus passages or remove polyps or scar tissue."
[edit]
"But the breakthroughs extend beyond sinusitis.
Chronic lower back pain, which hobbles an estimated 65 million
Americans a year, according to the Mayo Clinic, also has some new
remedies.
One is Botox, the same toxin responsible for erasing the furrowed
brows of appearance-conscious women and men across the country. At
least four small studies in the last several years in the United
States and England found that injections of the botulism toxin A at
the site of back pain reduced pain by as much as 50 percent in people
for whom traditional treatments had been ineffective.
The beneficial effects sometimes wore off after several months.
Doctors say the drug may at least temporarily reduce muscle spasms or
the pain sensory input to the spinal cord.
Another promising treatment: A lidocaine patch. Although the U.S. Food
and Drug Administration has only approved the drug for the treatment
of shingles-related pain, doctors report success in using it for back
pain.
The patch, which contains 5 percent lidocaine, is placed directly at
the site of the back pain, releasing the medicine to the nerves under
the skin. In clinical trials, the treatment was shown to significantly
relieve pain without causing serious side effects.
Pain is also the bane of the nation's estimated 26 million migraine
sufferers. But here, too, breakthrough therapies are providing
dramatic results.
The introduction a decade ago of a class of drugs called triptans --
which mimic the neurotransmitter serotonin, in short supply during
migraine attacks -- have revolutionized treatment of the debilitating
headaches.
And medicines that have been used successfully for other health
problems are offering results for migraine sufferers. Beta blockers
and calcium-channel blockers, both used to treat high blood pressure
and cardiovascular disease, have been effective in preventing
migraines, as have anti-seizure medications used for epilepsy and
bi-polar disorders.
And Botox injections appear to reduce migraine symptoms, too."
=================================================
Overcoming Chronic Pain - White Paper
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=4331
"More than 75 million Americans suffer from chronic pain.
Although pain acts as a warning sign of disease or injury, chronic
pain is not protective and can be debilitating. In the United States
alone, medical treatment and lost workdays due to chronic pain cost an
estimated $70 billion per year."
[edit]
NEW MEDICATIONS OFFER HOPE
"One new treatment found to help is the toxin known as BOTOX. It is a
highly purified form of botulinum toxin type A that is approved for
treating muscle spasms and for experimental use by dermatologists.
Mike Royal, M.D., J.D., Medical Director of the Pain Evaluation and
Treatment Center in Tulsa, Oklahoma, is conducting innovative research
using botox to treat patients with low back pain and myofascial pain.
Botox prevents the release of acetylcholine at the neuromuscular
junction, and stops muscle spasm, thereby reducing pain. Dr. Royal
reports improvement in 70 percent of patients in his study group who
received botox.
ZICONITIDE, a promising new drug for pain, is in the final process of
clinical trials for FDA approval. This very potent drug is made from a
toxin found in marine snail venom called conotoxin. Edgar Ross, M.D.,
Director of the Brigham and Women's Hospital Pain Management Center in
Boston, recently completed clinical trials testing the effectiveness
of Ziconitide. He said that it is several thousand times more potent
than morphine for pain, and appears to be safe when used long-term. In
the trials Ziconitide, a protein, was injected into the patient's
spine in combination with morphine.
A poisonous frog from Ecuador has helped scientists to discover a pain
medication 200 times as effective as morphine, but without the side
effects. Stephen Arneric, Ph.D., leads the research group at Abbott
Laboratories that created ABT-594, a non-toxic drug that is chemically
similar to the frog poison. Clinical trials are underway to test the
effectiveness and side effects of ABT-594, and initial results are
positive.
According to Russell Portenoy, M.D., Chair or the Department of Pain
Medicine and Palliative Care at Beth Israel Medical Center in New York
City, there have been great advances in the delivery systems for drugs
that treat pain. Extended release tablets, skin patches, and
continuous release systems implanted in the arm are helping patients
to manage their pain more effectively.
A research team led by Edgar Ross, M.D. at the Brigham and Women's
Hospital in Boston was recently involved in clinical trials on the
drug PREGABALIN. The drug that reduces the pain and fatigue caused by
fibromyalgia. While Dr. Ross says the results appear extremely
promising, clinical trials have been temporarily put on hold due to
some complications discovered in animal studies. A few of the mice
from the early studies developed tumors which caused concern among the
manufacturers of the drug and the FDA. Dr. Ross says the mice used in
the study were a strain of mice at higher risk for tumors. While most
drug companies have stopped using this type of mouse for their studies
because of this reason, they were still used during the pregabalin
studies. Dr. Ross says he remains optimistic about the drug's
potential.
PAIN RELIEF WITH ANESTHESIA
NERVE BLOCKS can relieve pain by stopping the impulses that travel
along nerves in the body. The physician injects a local anesthetic
along the course of the nerve or nerves associated with the pain.
SPINAL INFUSION involves the delivery of low doses of medications like
morphine through a catheter inserted in the spine.
SURGICAL TREATMENT OF CHRONIC PAIN
Most experts say that surgery is a treatment of last resort. For many
patients surgery can magically cure their pain, but, the risks are
high. Surgery can destroy other sensations in the body or become the
source of new pain.
IMPLANTED DRUG DELIVERY SYSTEMS are used for patients with very
resistant pain. These systems are expensive but offer a more
convenient, portable and efficient way to take medications.
IMPLANTED DORSAL COLUMN STIMULATOR is a device that allows a patient
to stimulate spinal nerves with mild doses of electricity, producing
relief by short-circuiting pain impulses. This method is being used to
treat pain caused by nerve damage and angina.
JOINT REPLACEMENT is the surgical replacement of a joint with a
prosthesis. This procedure can be a successful treatment for
rheumatoid arthritis and osteoarthritis.
SYMPATHETIC BLOCKS cut some of the sympathetic nerves, reducing pain
for some patients.
ABLATIVE SURGERY cuts one or more sensory nerves and blocks sensation
from the parts of the body affected by that nerve.
NON-INVASIVE CHRONIC PAIN TREATMENTS
PHYSICAL THERAPY helps patients with chronic pain to improve
flexibility, strength, endurance and conditioning thereby reducing the
disability caused by chronic pain. Techniques include postural
correction for patients with back pain, hot and cold therapy,
ultrasound and massage.
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) uses mild
electrical impulses delivered to the skin by hand held device. It is a
popular method of relieving joint and muscle pain. TENS works by
increasing endorphins and stimulating the nerve fibers, altering the
balance of painful stimuli entering the spinal cord. It can be worn in
a pocket and transmits an electrical impulse through electrodes taped
to the body in the area of pain.
CHRONIC PAIN AND THE MIND/BODY CONNECTION
Pain, depression, anxiety, and insomnia are intimately connected.
Patients have found that making behavioral changes to support a
healthier lifestyle can dramatically reduce their pain and improve
their mood. Changes in diet that result in weight loss can have a
positive effect on back pain and arthritis. Exercise increases the
level of natural painkillers produced in the brain (endorphins) and
can help reduce anxiety, depression and weight as well as stress.
For many people, stress contributes to both physical and mental
illness. It has been linked to migraine headaches, back pain, and
peptic ulcers. Stress causes the muscles in the body to tense up and
worsen the pain. Many people find pain management easier when they
reduce or eliminate stress in their lives.
STRESS MANAGEMENT TECHNIQUES such as deep breathing, progressive
muscle relaxation, autogenics, and imagery can be effective.
BIOFEEDBACK teaches patients to monitor the level of tension in the
body. When used in conjunction with relaxation techniques, biofeedback
can help people to manage chronic pain caused by muscle tension and
spasm.
COGNITIVE BEHAVIORAL THERAPY
"Actually, all pain is in our heads, as the brain mediates pain
signals. Even though pain is not just in our minds, we need to use our
minds as part of the solution to this problem that is as old as human
civilization."
Anne-Marie Deutsch, Ph.D., psychologist.
For the past 20 years pain experts have incorporated the mind into the
comprehensive treatment of pain. Success is greatly enhanced when the
patient's emotional and psychological response to pain is addressed.
Since pain is a perception, many psychologists believe that it can be
modified using various psychological interventions. The goal of
cognitive behavioral therapy (CBT) is to help people change irrational
thinking, misperceptions and negative thoughts. According to
Anne-Marie Deutsch, Ph.D., a psychotherapist specializing in the
treatment of pain, "Cognitive behavioral therapy is quite effective in
reducing the intensity of pain and in reducing 'pain behavior,' but it
needs to be continued periodically as effects have not been found to
be long term."
Hypnosis is a technique in which an individual's susceptibility to
suggestion is increased. The role of hypnosis in treating chronic pain
is uncertain. Some studies have shown that 15 percent to 20 percent of
hypnotizable patients can manage their pain with hypnosis. Other
studies report that hypnosis reduces anxiety and depression, and
therefore helps to diminish pain.
ALTERNATIVE THERAPIES FOR CHRONIC PAIN
ACUPUNCTURE is an ancient method of pain and disease control
discovered in China as early as 3000 B.C. This treatment involves the
insertion of fine, disposable needles into tiny places on the skin
called acupuncture points. The needles are sometimes twirled or
accompanied by mild electrical currents or lasers.
Acupuncture is believed to regulate the flow of positive and negative
energy along channels in the body called meridians. When the normal
flow of energy is blocked, this Chinese theory says, physical and
mental problems result until the balance is restored. Acupuncture is
believed to work because it stimulates better circulation to the
tissues, releases tension in the muscle surrounding the acupuncture
point, and releases endorphins into the spine and brain. Acupuncture
is used to treat:
Headache
Backache
Arthritis
Neuralgia
Depression
MASSAGE is probably the oldest method of relieving muscle pain,
swelling and stiffness. Massage relaxes tense muscles, and reduces
pain by dilating the blood vessels and stimulating circulation. An
increase in blood flow to muscles helps carry away the chemical
by-products produced by inflammation, and thus soothes nerve endings.
A study in Norway found that massage increases levels of endorphins by
about 16 percent, and may help to increase serotonin as well.
MAGNET THERAPY is a billion dollar business based mostly on anecdotal
evidence and very little scientific research. Advocates believe that
magnets increase circulation and stimulate the body's natural healing
process. But, in an article published in the Washington Post, Robert
Park, Ph.D., a physicist from the University of Maryland, found no
plausible explanation for how magnets could relieve pain. Park says
that magnet therapy is, for the most part harmless, but it is not
recommended for people with pacemakers or metal implants.
On his Web site, Andrew Weil, M.D., a best-selling author and advocate
for complementary medicine discusses several alternative treatments
for chronic pain.
Weil recommends the use of ginger as an anti-inflammatory treatment
for arthritis, and Arnica Montana as good homeopathic remedy. Yoga, he
says, can help to manage chronic pain because it reduces stress,
strengthens the back muscles, and promotes flexibility.
CONCLUSION
In the past, chronic pain has been undertreated and poorly managed in
the United States. Over the last 10 years, significant improvements in
the treatment of chronic pain have brought this issue into the
forefront of American health care. Experts feel that real change will
not happen until patients demand better care for their chronic pain.
In addition, optimal pain care cannot be delivered until financial
concerns of patients in a managed care system are addressed."
=================================================
Denver Pain Management Forges New Frontiers in Treatment of Chronic Spinal Pain
http://www.healthpsych.com/bhi/bbhi/dpm.html
Ongoing Research Explores More Effective Techniques
"In complement to its clinical practice, DPM conducts research on
promising new treatments for the reduction and relief of chronic
spinal pain. One of DPM?s current clinical trials centers on comparing
systems for the advanced treatment of lumbar disc pain, a condition
that affects five million people in the U.S. and is the number one
cause of health care expenditure. Traditional surgical approaches
(e.g., discectomy and fusion) involve open dissection of soft tissue
and bone. In the interest of improving patient outcomes and decreasing
recovery time, DPM is investigating the use of minimally invasive
techniques that can safely and effectively remove disc material and
decrease pain.
Specifically, DPM is testing two methods for long-term effectiveness
at improving the patient?s quality of life: radio frequency energy
applied with a variety of advanced treatment tools and techniques as
well as a new, minimally invasive means of mechanical decompression of
the disc. Clinic patients are enrolled in these studies based on their
failure to respond to traditional and conservative therapy.
Another clinical trial underway at DPM focuses on testing the
effectiveness of different early intervention techniques with spinal
cord stimulation for the treatment of Complex Regional Pain Syndrome
(CRPS). This physically and psychologically incapacitating syndrome is
characterized by sensory, motor and autonomic disturbances. With CRPS,
pain occurs in a regional distribution that does not correlate to a
single peripheral nerve. Often, the degree of pain experienced by the
sufferer is disproportionate to the event that caused the original
injury.
There appears to be little doubt that early intervention results in
favorable outcomes for CRPS patients. However, the question of which
interventions are most effective is still open to debate. To address
this issue, the DPM study is comparing the effectiveness of more
traditional treatments (i.e., sympathetic nerve blocks, physical
therapy, medication) to treatment using a percutaneous spinal cord
stimulator. Patients with CRPS are randomly divided into two groups,
each group receiving one of the two methods of treatment.
In yet another clinical trial, DPM is following a group of patients
from evaluation through a series of diagnostic / therapeutic
injections to gain a better understanding of the effectiveness of this
form of treatment. This non-randomized study will track patients to
determine if they have experienced a reduction in pain without having
received further interventional treatment."
[edit]
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Actiq Shows Promise In Treating Breakthrough Pain
http://www.pslgroup.com/dg/6E33E.htm
http://www.actiq.com/patients/aboutactiq/whatisactiq.asp
What is ACTIQ?
ACTIQ is a prescription medication that contains a strong
pain-relieving drug (opioid analgesia) called fentanyl. The ACTIQ unit
consists of a medicated, raspberry-flavored lozenge that is attached
to a handle
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Chronic Pain Home Treatment
http://my.webmd.com/hw/pain_management/tr2781.asp
Chronic Pain Medications
http://my.webmd.com/hw/pain_management/tr2783.asp
Artificial Spinal Disc Nears Approval
http://my.webmd.com/content/article/88/99801.htm
Pain Management: Routes to Relief-- Lori Schmitt, RN and Ayman Basali, MD
http://my.webmd.com/content/article/82/97507.htm
=================================================
Freedom from Pain: The Breakthrough Method of Pain Relief Based on the
New York Pain Treatment Program at Lenox Hill Hospital (Book)
http://www.medicine-book.com/Freedom_from_Pain_The_Breakthrough_Method_of_Pain_Relief_Based_on_the_New_York_Pain_Treatment_Program_at_Lenox_Hill_Hospital_0671511653.html
=================================================
keyword search:
chronic pain treatment new breakthroughs
medtronic pain pacemaker
cancer pain treatments
chronic back pain treatments
headache migraine pain treatments
clinical trials pain management
Best regards,
tlspiegel |
