Make Pain a Thing of the Past – pain – Physician Partners of America

Tag Archive for: pain

Treatment for Arthritis

Millions of people across the country experience pain from arthritis every day. The pain can range from mild discomfort to debilitating.

Effectively treating arthritis depends in large part on the severity of the condition and any related conditions.

Pain specialist Dr. Alik Saidov of Physician Partners of America in Arlington, TX, treats patients with varied arthritis-related conditions on a regular basis.

Below he provides some insight into treatment options and how best to prevent becoming arthritic.

 

Question: I take over the counter medication for my arthritis, but it’s not effective. What are other treatment options are there?

Dr. Saidov: “First, the pain should be evaluated by a specialist to determine the cause of arthritis. It could be from most common type “wear-and-tear” osteoarthrosis or a part of underlying pathology (e.g. rheumatoid arthritis, psoriasis, etc). The treatment options may vary from simple OTC medications to very strong pain and anti-inflammatory medications and injections into joints.”

Q: Are there specific things I can do in my daily life to reduce arthritis pain?

Dr. Saidov: “This depends on the type of arthritis. Recommendations could range from physical therapy to increase range of motion, to cold/warm applications, braces and more.”

Q: Since I know I have arthritis, are there any other conditions I should keep an eye out for?

Dr. Saidov:  “It could be from most common type “wear-and-tear” osteoarthritis or a part of underlying pathology (e.g. rheumatoid arthritis, psoriasis, Lupus, avascular necrosis, etc). It is important to be evaluated by a specialist first.”

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Stop Suffering From Neck Pain

Millions of people suffer from mild, moderate or severe neck pain every year. Many of them are enduring chronic, lasting pain and try in vain to combat it with run-of-the-mill OTC medicine like aspirin or ibuprofen. Needless to say, the relief is fleeting, if anything at all. That’s not how to treat neck pain.

Let’s back up and talk about what neck pain is. When the neck muscles are strained from poor posture from leaning over your computer, hunching over your desk at work, sleeping in awkward positions, a car accident, a sports injury or anything that caused stiffness and discomfort – that’s neck pain. Next, let’s take a look at some symptoms up close.

Neck Pain Symptoms

You know you have neck pain when you experience any of the following symptoms:

  • Muscle tightness and spasms in your neck
  • Decreased head range of motion
  • A headache that extends into the neck

Now, these symptoms may be a one-time thing and perhaps an ice pack or heating pad will take care of it. However, if you’re finding that this pain keeps coming back it may be chronic, and in that case, you need to move on to more advanced medical treatments.

Neck Pain Treatment

  • Physical therapy. Posture correction, neck-strengthening exercises, and alignment techniques can help ease your discomfort and potentially stop future pain.
  • Transcutaneous electrical nerve stimulation (TENS). This technique employs the use of electric currents produced by a device to stimulate the nerves for therapeutic purposes.
  • Steroid injections. A procedure where steroids are injected into the nerves of the neck to stop their ability to send pain signals to the brain. This is an effective way to gain immediate pain relief through minimally invasive means.

Get Neck Pain Relief Today

Don’t wait another painful day. Contact Physician Partners of America now or schedule an appointment to be connected with a pain expert who can help manage your condition and get you back to living a full, active life.

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How Health and Fitness can Prevent Chronic Pain

For many adults who experience chronic pain on a daily basis, their symptoms are exacerbated by a poor diet and little or no daily exercise.

Being proactive in maintaining a health and wellness routine can pay off

down the road when you are older.

Pain management specialist with Physician Partners of America offers a few tips for getting on the right track to living a healthy life and minimize the risk of pain from poor health.

 

Question: What kind of exercises should I be doing on a regular basis?

Dr. Michels: “It’s important to find fun exercises that get you moving every day. Things like walking a dog, riding a bike or going for a swim. The goal is to progress to strength training two or three times per week. Some great strength training exercises are push-ups, pull-ups, bodyweight squats and planks.”

Question: Eating well is hard to do. What kind of advice can you give me?

Dr. Michels: “Have three moderate-sized meals per day with healthy snacks in between, The goal is to never actually be hungry. Don’t overindulge. Some healthy snacks are raw almonds; vegetables such as carrot sticks, broccoli and celery; and whey protein shakes with almond milk, fresh spinach, and dark berries. When at the grocery store, shop the perimeter of the store. That’s where you will find fresh fruits, vegetables, and meats. Don’t forget about whole grains, too.”

Q: What kinds of foods should I avoid?

Dr. Michels: “Steer clear of processed foods, sugary drinks such as soda, candy, and food containing high fructose corn syrup. Also stay way away from flours and processed grains.”

Q: How much water should I drink every day?

Dr. Michels: “Start every day with an 8-ounce glass of water to re-hydrate. You should drink half your body weight in ounces per day. We often confuse thirst for hunger. Before running to food, drink an 8-ounce glass of water and see how you feel.”

Q: What kinds of goals should I set for myself?

Dr. Michels: “Start small and set easily attainable goals. Build off of the momentum of success. Write your goals down and put them somewhere you can see them daily. Once you have accomplished a goal, set a new one. Remember, show yourself grace. If you fail, pick yourself up and start again.”

Q: I hear people talk about “cheat days” – what are those? Are they OK?

Dr. Michels: “Allow yourself to experience the joy of accomplishing a goal. All yourself to have “cheat days” where you can enjoy something that may not be the best for you (i.e. birthday cake at a party, pumpkin pie at Thanksgiving.) Live by the 80-20 principal – 80% of the time eat healthy, 20% of the time eat what you want.”

Q: How can I stay focused on healthy living?

Dr. Michels: “Create a vision board: if you can see it, you can be it. A picture is worth a thousand words. Change the ‘way’ of thinking about diet and exercise – it’s not punishment, it’s reward. Think of how much better you are going to feel, look and be. By committing to a healthy lifestyle, it will enable you to finally start living. Have a “can-do” attitude. Consider healthspan vs. lifespan. It’s not the length of your life, but the quality of your life that matter.”

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Whiplash Treatment in Tampa

Suffering From Whiplash?

You’re headed home in typical Tampa rush hour traffic. People are getting out of work and piling into their cars to get home like everyone else. The light turns red and you stop. Suddenly… another car rear-ends you while sitting at the light. Of course you weren’t expecting this, so your head violently jerks forward and back as your car is pushed several feet into the middle of the intersection.

Dazed. Confused. You slowly get out of your vehicle and look back at the other driver who’s already panicking. Surprisingly, you’re not in any pain right now, but once the shock and adrenaline wear off, you may begin to feel severe neck pain, stiffness, and headaches. That’s called whiplash and it’s serious.

How to Tell If You Have Whiplash

As we said, the warning signs for whiplash probably won’t show themselves right away. The adrenaline rush and shock must first subside before the pain of the injury can show itself. Some of this warning signs – or symptoms – can be:

  • Neck pain and stiffness
  • Painful neck movement
  • Range of motion decreases in the neck
  • Headaches
  • Shoulder pain and/or tenderness
  • Tingling down the arms

Our Pain Experts in Tampa Can Treat Whiplash

Of course our example was a car wreck, but a person can get whiplash from a variety of events such as a sports injury or traumatic accident. You should contact the pain experts at Physician Partners of America if you begin to experience any of the listed symptoms above in addition to any other neck pain after any injury you may have received. Getting a prompt diagnosis – and treatment if whiplash is the case – is vitally important to restoring full mobility of your neck and to eliminate the pain.

Remember, you may not feel the pain right away. Don’t dismiss the fact that the injury occurred and the effects are on the horizon. Better safe than sorry, right? With that in mind, even if you’ve been injured, but don’t think it’s whiplash, let our pain management team here at Physician Partners of America take a look.

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Florida Pain Relief Group Patient Story

For many people suffering from chronic pain, the prospect of finding real and lasting relief can be a complete life-changer. Throughout his years of practicing pain management, Dr. Gari has had an immeasurable impact on people’s quality of life.

We often get brief notes of appreciation from patients. Few offer as much detail about their life with chronic pain as this patient. He has asked to remain anonymous, but he granted us permission to share his message and experience here on our website.

 

Though I’m a relatively new patient of Dr. Gari’s I do like his approach to pain management. A lot of doctors are simply there to be paid and write prescriptions; Dr. Gari actually wants to solve the problem, and to make sure that it doesn’t come back.

He isn’t afraid to try aggressive therapies that, while safe for the patient, avoid the risk of addiction or surgery for surgery’s sake. I would complain that it’s a time-consuming process; just in the next two weeks I’ve got four appointments with him, two of those being surgical procedures, but comparing that to the amount of time spent complaining about pain, the loss of ability to focus and the trouble that comes with chronic pain, it really isn’t much.

Wouldn’t you rather trade eight hours of your month for the stress of medication management, finding the right doctor, balancing the limitations in your life? I’m relatively young for a client of Dr. Gari’s and I’m not sure if it’s sports related or if it’s simply bad luck, but he’s been nothing but professional with me.

The first time I tried to “solve” my back pain problem I was referred to a doctor who simply started with narcotics. After a month or so of taking these, that doctor wanted to introduce the epidural injection procedures with a $1,200 co-pay (cash only, of course). If I wasn’t willing to pay for these procedures out-of-pocket and out-of-network, he simply wouldn’t write me any more prescriptions.

I was somewhat taken hostage by a new-found addiction to over-prescribed medication that was increased frequently to match my tolerance. Eventually, it got to the point where I simply wasn’t willing to continue down that path, but I, unfortunately, turned to heavy drinking to deal with my ever-increasing back pain.

I’ve met a few doctors as it’s important to find someone you trust. It’s almost like a therapist in this way; you need someone who’s going to believe you when you say you can’t enjoy your life anymore.

This can be difficult when you’re young(er); I’m 34 and doctors often brush me off before they’ve even bothered to look at my MRIs. Again, it’s like mental illness – you can’t see it, it doesn’t show up on a test and it’s impossible to measure in any quantitative way. P

Personally, my two favorite things in the world were running and scuba diving; with a herniated disc, as you can imagine, there are restrictions on participation for either with back pain. Dealing with pain by avoiding doctors and simply drinking it away makes you too stupid and too fat to enjoy either and you find yourself depressed, eating more, drinking more, weighing more.

Dr. Gari gives you another option – get rid of the problem that’s driving you to such measures. That’s worth more than gold. I want my life back, Dr. Gari can give it to me. If these epidurals don’t work, I’ve been asked if I’d consider medication. Normally, I wouldn’t; under Dr. Gari’s supervision, I would.

He’s meticulous, careful to the extreme, and knows what options there are. I’ve tried physical therapy on its own, medication on its own, epidurals on their own – but my treatment is being tailored to my life and lifestyle. With any luck, this time next year I’ll have lost another fifty pounds and I’ll be watching orca hunt off the west coast of Costa Rica from a private charter.

Chronic pain can take your life away. You’re willing to do anything to make it stop. Dr. Gari knows how to do this properly and how to do this safely. He’ll have saved my life.

Drinking? Done with it.

Depression from the seemingly endless pain to which there’s no solution? Gone.

Psychiatric medicine that puts you in a haze so you don’t know what’s going on? No thank you.

Spending days in bed curled into a ball screaming into a pillow? Not anymore.

Considering suicide just to make it go away?

Poor job performance because you can’t think about anything but the feeling that you’re on fire from the waist down all day and night?

Not on Gari’s watch.

I have faith this time around, and I can only hope it will be rewarded. I think it will.

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Pain Experts

Experts In Pain Relief

You’re either suffering from pain right now or you just were which has led you to this website article. Not that we’re looking through a crystal ball or anything, but you’ve probably also been suffering from this pain for longer than you’d like to admit – and nothing has worked so far to relieve it.

Sure, popping two or three Tylenol may numb the pain for a few hours, but just when you’re able to move around relatively pain-free, the medication stops and the hurting restarts. This is a vicious circle of chronic pain you have found yourself in and the only way out is with the pain experts at Physician Partners of America.

Pain Isn’t One-Dimensional

Let us drop a little nugget of wisdom here: Pain is physical and emotional. That’s right. While there is no denying that you have lower back pain or neck pain or any other type of chronic pain, that very pain begins to take a psychological and emotional toll on your body. This causes stress levels to rise, and stress is where many bad things can begin to take place. In this instance, the pain leads to more stress which can lead to more pain which can lead to more stress…you get the picture.

The pain experts have the right treatments and therapies to end this cycle and get you out of the pain loop. If this was a more mild, acute type of pain we were discussing then perhaps you could handle this on your own. However, since this is persistent, constant, limiting pain you need the professional pain management that Physician Partners of America brings to the table.

Contact Us Today, Live Pain-Free Tomorrow

Since we offer same-day appointments, it is possible that if you walk into our clinic today, you’ll be living a pain-free or at least a much more painless, life starting tomorrow. Our doctors are experts in pain and our methods are unparalleled. We specialize in helping our patients live without pain. How does that sound to you?

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The Importance of EMG and Nerve Tests

During the course of a patient’s treatment for chronic pain, their physician may suggest the need for additional testing.

The reasoning for needing more testing is to get a better handle on a patient’s specific pain management needs. Among the testing that a physician may recommend is a study of how a patient’s nerves and muscles are working.

Dr. Prasad, a pain specialist in Dallas-Fort Worth, performs this test on his patients during the course of treating their chronic pain. Below he answers a few basic questions about what an EMG and NCS test means.

 

Question: What is an EMG/NCS test?

Dr. Prasad: “EMG stands for Electromyogram and NCS stands for Nerve Conduction Study. These are diagnostic tests to check on how a patient’s muscles and nerves are functioning. The results from this test will help a pain specialist to diagnose the severity of a patient’s condition and accurately map put appropriate treatment options.”

Question: Why am I being referred by my doctor to get an EMG/NCS test done?

Dr. Prasad: “You may be referred for this test if you experience numbness, tingling or a burning sensation; muscle weakness such as foot drop, wrist drop, difficulty opening jars; back pain shooting down your leg, or neck pain shooting down the arm.

Q: What will happen during the test?

Dr. Prasad:  “During nerve testing, small electrode patches are applied to the skin over certain muscles and/or nerves. Then the overlying skin is gently electrically stimulated to see the nerve response. During EMG testing a small, thin needle is used very briefly to test how well the nerve and muscle are working together. There is no electric stimulation involved during EMG testing.”

Q: Is there anything that I should do before having the test?

Dr. Prasad: “Avoid wearing skin lotions, oils or creams on the day of the test. Wear comfortable, loose-fitting clothing that allows access to muscles and nerves to be tested. Generally speaking, patients can take their usual medications for blood pressure, diabetes, thyroid, and others as prescribed by their physician. However, if you are taking a blood thinner, please notify the doctor in advance.”

Q: Are there any restrictions before or after completing the EMG/NCS test?

Dr. Prasad: “There are no restrictions on activity before or after the test, and there are no lasting after-effects.”

Q: When can I expect the results of this test?

Dr. Prasad: “After completing the EMG/NCS test, the doctor has to look at all the findings before making the interpretation. The test results will be sent to your doctor that referred you for the test. They will discuss the results during your follow up visit.”

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How to Treat Spondylolisthesis

Pain caused by injuries to vertebral bones can be severe and long-lasting. For many it’s a kind of pain that places significant limits on a person’s ability to enjoy life. Daily activities once taken for granted are now a struggle, if not impossible, to complete due to chronic, severe pain.

One conditions people with vertebral injuries experience is called spondylolisthesis. Pain specialist Dr. Robert Nocerini has experience treating patients across Dallas at his office in North Dallas.

Dr. Nocerini sheds some light on what spondylolisthesis is, how it occurs and what treatment options are available to chronic pain patients in Dallas, TX.

 

Question: What is Spondylolisthesis?

Dr. Nocerini: “Spondylolisthesis is a condition in the spine in which one vertebral bone slips forward relative to the one beneath it. The degree to which it slips forward is graded on a scale of 1 to 5, with lower grades representing mild cases, and higher grades representing more severe cases.”

Question: What are vertebrae or vertebral bodies?

Dr. Nocerini: “The typical human spine is made up of a series of bones called vertebrae, or vertebral bodies. From top to bottom, there are 7 cervical vertebrae in the neck, 12 thoracic vertebrae in the upper back, 5 lumbar vertebrae in the lower back, 5 sacral segments fused into one sacrum, and 4-5 small bones that make up the coccyx. In a spine with normal alignment, each vertebral body is centered on the one beneath it, with an intervertebral disc separating the two bones.”

Q: Where does spondylolisthesis occur?

Dr. Nocerini: “Spondylolisthesis commonly occurs in the lower lumbar spine, usually at the L5/S1 disc space where the lumbar spine meets the sacrum, but it may also occur at L4/5 or other levels.”

Q: What are the different types of spondylolisthesis?

Dr. Nocerini: “The most common types of spondylolisthesis are isthmic and degenerative.

Isthmic Spondylolisthesis tends to develop in childhood or as a teen in around 6% of the population. It is caused by a fracture in part of the vertebral body called the pars interarticularis, which is part of the neural arch of the spine. This section protects the spinal cord and the spinal nerve roots as they come off the spinal cord. The term for this type of fracture is “spondylolysis,” also called a “pars fracture.” The terms can start to sound alike, as there is also a very common spinal condition called “spondylosis,” which is degenerative osteoarthritis in the spine. A pars fracture may occur from participating in sports that require extreme back bending or from heavy lifting, so participants in gymnastics, diving, football, and wrestling have a higher risk of developing spondylolisthesis than the general population.

Degenerative Spondylolisthesis tends to develop in the sixth or seventh decade of life. This occurs due to degeneration of the small joints in the back of the spine called the facet joints, and weakening of the spinal ligaments, which help hold the spine in alignment. “

Q: Is spondylolisthesis always painful?

Dr. Nocerini: “Many people do not have any symptoms from spondylolisthesis. Others may have low back pain, which increases when leaning back, and they may have tight hamstring muscles and thigh pain.”

Q: How does spondylolisthesis cause pain?

Dr. Nocerini: “Spondylolisthesis may cause pain by affecting the spinal nerve roots. When one vertebral body slides forward on top of another, it causes a narrowing of the spaces on the sides of the spine through which the spinal nerves travel. These spaces are called neural foramen, and the narrowing is called neural foraminal stenosis. This pain may be felt in the back and radiate down one or both legs. Spondylolisthesis may also cause pain by creating traction on the intervertebral disc below the vertebral bone that is slipping forward. As the spine slips forward on top of the disc below it, the increase in shear force may cause degeneration of the disc and disc pain. Also, enlarging facet joints can encroach on the spinal canal causing symptoms similar to spinal stenosis, such as leg pain.”

Q: How do you diagnose spondylolisthesis?

Dr. Nocerini: Radiological evaluation of spondylolisthesis usually starts with plain x-rays. Evaluation might include standing x-rays, as spondylolisthesis might resolve when lying down for imaging. Flexion/extension x-rays may also be indicated to determine if the vertebral bodies shift position with movement, indicating an unstable spine. A CT scan may give more information about a pars fracture, and an MRI may help to diagnose any nerve root impingement, stenosis, or disc abnormalities.

Q: How is spondylolisthesis treated?

Dr. Nocerini: “In mild cases, pain medication and physical therapy may be helpful. Physical therapy generally consists of exercises that strengthen the muscles that make up the “core,” or the muscles that support the spine, such as the back muscles, abdominal, and oblique muscles. In cases where conservative measures such as these are not helpful, epidural steroid injections may be helpful, specifically targeting the nerve roots that are being compressed by the slipping vertebral body, facet joints or disc. In severe cases where medications, physical therapy, and injections are not helpful, surgery may be indicated to align the spine.”

Q: Can I still be active if I have Spondylolisthesis?

Dr. Nocerini: “In most cases of spondylolisthesis, individuals may still participate in sports and physical activity. Each case is individual, however, and the decision to participate in physical activity, along with the degree of participation, should be guided by a qualified medical provider.”

Do you still have questions about your chronic pain needs? Contact us today!

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Common Misconceptions about Pain Management

Every day millions of people across the country see pain management specialists for help with their chronic pain conditions.

However, there remain many misconceptions about what pain management is all about. In an effort to dispel some of those misunderstandings and misconceptions, Dr. Rodolfo Gari, Medical Director of Florida Pain Relief Group in Tampa, FL, answers some of the more common questions people have about pain management.

“Doesn’t pain management just involve patients taking a lot of pills?”

Dr. Gari: “The needs of people suffering from chronic pain are ever-evolving, and pain management has evolved along with it. For some patients, medication management may be the best course of action. However pain management and pain relief is far from one-size-fits-all. At Florida Pain relief Group we take a comprehensive approach to pain management. This approach involves physical therapy, nerve blocks, minimally invasive procedures and also include medication management.”

“Aren’t pain management doctors like chiropractors?”

Dr. Gari: “At Florida Pain Relief Group, unlike chiropractors, our physicians attended medical school and have specialized training following medical school. This specialized training involves a one year internship in a field such as Internal Medicine or General Surgery, a three to four residency in a field such as Anesthesiology and another year called a fellowship in the field of pain management. This medical training amounts to about nine years of medical training after graduating from college.”

“All pain management doctors are the same.”

Dr. Gari: “At Florida Pain Relief Group our physicians are interventional pain management physicians. Unlike other pain management physicians that can only prescribe medications, our
physicians perform nerve blocks, spinal cord stimulators, intrathecal pump implants, rhizotomies, and other minimally invasive pain management techniques to lower your pain level, thereby reducing your dependence on opiates and other strong medications to control your pain.”

Do you have a question about pain management that wasn’t answered here? Contact us today!

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Facet Joint Arthritis – A Common Cause of Low Back and Neck Pain

What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.

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