How to Relieve Pain with Osteoarthritis Exercises

Osteoarthritis (Degenerative Joint Disease) affects millions of Americans every day, and suffering individuals are looking for ways to relieve their pain. Osteoarthritis pain occurs when the cartilage has worn away on joint ends. When you’re in pain, exercise can be a daunting thought. Research has shown that building up the muscles around the joints can slow the progression of Osteoarthritis. Remember it’s never too late to get moving. Try these easy osteoarthritis exercises to relieve pain.

Water Aerobics

Looking for a beneficial exercise that is low impact and provides strength-building? For those who think that pumping iron or squats and lunges are too daunting, try a water aerobics class. Water aerobics classes often use water weights for extra muscle development. If you already have joint pain, then water aerobics won’t put any extra stress on your body.

Wall Slides

Wall slides mimic sitting in a chair, but with the help of a wall. Press your back firmly against a wall and then lower your body down in a seated position. Once in position, slowly rise up. Try to complete 10 to 12 reps. If this is difficult, you can also try this exercise with an exercise ball.

Hamstring and Calf Stretches

It is important to keep the legs and knees strong. Before any routine, stretching is of the most important thing to remember. For an effective hamstring stretch, sit on the ground, put one leg out in front of you and bend the other leg with the foot level with your knee. Stretch forward as far as you can comfortably go. Switch legs and repeat.

Half Squats

Often times, a full squat seems difficult. If this is the case, try a half squat. This type of squat can be very effective for strengthening the legs and knees. Start in a standing position, squat halfway down to a seated position (your legs should be at a 90-degree angle) and repeat.

Things to Remember

Most weight-bearing exercises will help keep your muscles strong and joints healthy. However, don’t overdo it, especially if you have joint pain. You can try yoga or pilates at your local gym. Remember, keep those muscles moving! Contact Campbell Medical Clinic at (832) 460-6468 to rid your life of Osteoarthritis today. Our doctors can help provide you pain relief and ensure you achieve your wellness goals.

At the end of the year, we start to get intensely excited and feel especially motivated to change our lives for the better once January 1 rolls around. We begin to pursue many goals, and often find our motivation was artificial and temporary. For many people, we aren’t able to devote the energy our lofty goals deserve, we lose focus, and eventually abandon our resolutions completely. In this article, we’ll look into ways you can be successful when you make a New Year’s resolution to be pain free.

When you have chronic pain, most people look to the medicine cabinet or drugstore. Unfortunately, medications usually only make you pain free temporarily—and they won’t cure what causes the pain or stop it completely. But there are plenty of approaches to try when it comes to your pain management strategies.

Setting Your Resolution

It’s important to create a manageable resolution—in other words, don’t be tempted to set more goals than you can reasonably achieve. Believe it or not, how you word your resolution can help you make it a habit. If you say “I intend to achieve <this goal>” is powerful. It gives you a purpose along with the clear assumption you’ll succeed, as opposed to “I want to achieve <this goal>.” Create a game plan, breaking down your resolution into the steps you’ll take to successfully tackle each of the milestones along the way. 

If you find something that doesn’t work, try a different approach with your resolution firmly in mind. Don’t beat yourself up if you don’t make considerable progress each day. You’re only human, and we all have days where we’re not at our best. For example, someone who resolves to exercise daily might want to rest instead while they have the flu. These things happen, so be prepared.

Tips for a Pain-Free New Year

It’s possible that you don’t have to live with chronic pain, relying on pills for the rest of your life. We’ve put together some drug-free options to help you remain pain-free. 

  • Massage. From deep tissue work to more gentle techniques, massage can help you relax. Its therapeutic benefits include relaxing muscles and sore tissues as well as easing chronic pain. 
  • Physical Therapy. You’ll learn how to gently and effectively move and stretch your muscles while working to strengthen your joints. Physical therapy can help the cause of your pain and may include exercises, stretching, or even water therapy that works your muscles in a pool.
  • Acupuncture. This is one of the world’s oldest pain management techniques. This Chinese practice uses tiny needles placed in specific spots on your body. Acupuncture promotes circulation, wound healing, and pain modulation. 
  • Hot and Cold Therapy. Heat—from a heating pad, a hot bath, or other source—boosts blood flow and allows muscles to relax. Cold—from ice or a cold pack—slows circulation and reduces swelling, slowing the body’s ability to send pain messages.
  • TENS Treatment. Transcutaneous electrical nerve stimulation (TENS) involves attaching small devices to the painful area. Electricity stimulates the nerves in the area where the pain is localized and reduces pain.

Therapy for the Mind. Our mental health affects our physical health. When you’re anxious, depressed, or stressed, it can manifest in physical pain, or at the very least might make you hyper-focused on your pain. Cognitive behavioral therapy (CBT) can teach you how to better manage your thoughts and emotions along with your body’s physical response. Biofeedback is another method that helps you learn how to control your body’s reaction to pain, and the deep relaxation of hypnosis can also help keep you pain free.

Busy physicians lack time, and sometimes training, to help complex pain problems. This can lead to frustrating encounters at the primary-care level, especially if your doctor is rushed. Most practices are forced to see a certain number of patients in a limited amount of time. Unfortunately, pain treatment is not as simple as five minutes, a few questions, and prescribing a pill. When pain is discussed, medications are often brought forth as the primary means of management. Because of its complexity, pain treatment has emerged as a separate, multidisciplinary specialty.

There is a source you can identify with a simple pain condition, such as banging your finger. There is also a clear course of action that resolves the pain. Pain experienced with long-term medical conditions is different and is not as easily resolved. To deal with the pain, the cause of the pain may not always be addressed, but rather the ways the body expresses the pain, such as inflammation.

Explain the way your pain impacts your life when you’re talking to your doctor. Don’t be intimidated. Stand your ground, calmly. Be persistent about your issues in a way that is constructive to get across to the physician that this is something real. Listen to what the doctor has to say first, but if you’re not satisfied, press harder. Remember you want to create a relationship with your doctor in which you’re a team, both looking for the best way to alleviate your pain. After he or she has assessed your needs, you can consider seeing a pain specialist.

Pain injections

There are various types of injections for pain treatment. Your doctor will decide which medicine is best. Injections deliver medicine directly where needed in your body. Local anesthetics numb the nerve or muscle. Steroids ease inflammation, which lowers pain. Steroids and local anesthetics are often used in conjunction.

  • Targeting the nerves along the spine that lead to pain in other areas, such as the arms or legs is what nerve blocks are used for.
  • Epidural steroid injections go in the outer part of your spinal column.
  • Trigger point injections focus on tight spots in muscles. These areas can be so tight they squeeze nerves and lead to pain in other places.

Radiofrequency Ablation (RFA)

Radiofrequency ablation can relieve pain for 8 months to a year. Nerves send pain signals to your brain, and the RFA is used to inhibit this. A needle with a heated tip is placed very close to the nerve. The heat effects the nerve so that it can’t send the pain signal. This pain treatment assists with many types of pain, including arthritis and neuropathy. Research indicates RFA can also ease lower back and hip pain as well as pain in the knee and neck. And, research is being conducted to see if a cooling type of RFA would be more effective than the heated form.

Opioids

Opioids are substances, both natural and synthetic, that act on opioid receptors in the body. They are primarily used for pain relief, including for anesthesia. While effective for severe pain, they also have numerous side effects. Further complicating matters, it’s not clear if opioids are helpful after a few months. And the most dangerous issue with opioids is that addiction is common among people who take them long-term.

Alternative and Complementary Therapies

Even though there may not be any increase at a pain site, with chronic pain, nerves may fire continuously. If some of the pain messages are interrupted, or if the brain can actually send out different chemicals such as endorphins, you may feel less pain and interrupt the chronic pain cycle.

There are techniques for using your thoughts to have an impact on your body—and body therapies that target how the use of the body can have an impact on your emotions. Generally, you can learn these and then do them yourself. Here are a few suggestions:

  • Abdominal breathing is done by taking deep breaths, initiating from the abdominals, holding the breath for a moment, and then releasing. It’s calming, opens the lungs, and gets more oxygen into the body.
  • Relaxation training involves learning how to relax the muscles of the body by letting go of tension in the muscle groups of the body.
  • Guided imagery involves the process of mentally imaging a calming, relaxing experience which can include releasing pain from the body.
  • Self-hypnosis is giving yourself some kind of signal to release the pain, allowing your body to relax more.
  • Meditation was developed to deal with all kinds of pain: emotional pain, the pain of dealing with life, the need to find some kind of peace and calm. Physical pain is often connected to emotional pain. Many people find that meditation can help calm their mind in response to pain.
  • Biofeedback is done using equipment to give you feedback, that helps tell you what’s going on in your body. Relaxation techniques are then used to help the body relax.
  • Acupuncture involves placing tiny needles in the skin at certain points on the body. Many studies show it can ease low-back pain and may also help for arthritis joint pain.

If you try a therapy and it’s doesn’t work for you, that’s fine. It’s important to be patient and work on finding the combination that provides you with the greatest relief. Be sure to share with your physician the techniques you’ve tried and how effective they were for you—this may help him or her determine future treatments for you.

As a natural health care provider, I am just not a fan of pharmaceutical drugs. In fact, patients showing up at my office while on a bunch of drugs is the biggest challenge to me because they just interfere so much with healing process.

But there is one drug I endorse and the drug is called naltrexone. Naltrexone has been around since 1960s and traditionally it’s been used in high dose like 50 to 300mg for treatment of opioid and alcoholic addiction. It blocks the opioid receptors of the body and help curb the cravings for opioid drugs and taste for alcohol. But when naltrexone is used in low dose, from 1.5 to 4.5mg, they only temporarily blocks the opioid receptors for a few hourly, fooling the body to produce more endorphins and other healing hormones.

What can low dose naltrexone therapy treat? Almost anything. Since what the drug does is fooling your body to produce more healing hormones, it can be used for a wide variety of illness but especially, it has a long documented success with autoimmune diseases.

I have used LDN. Therapy for:

  • Chronic pain
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Lupus
  • Fibromyalgia
  • Parkinsons
  • Cancers
  • Other chronic, neurogenerative conditions

Recently, a young lady with MS travelled from California for a round of stem cell therapy and she was put on LDN therapy. She just sent me the following message.

“Hi, just wanted to share how I am doing. My bladder is stronger and I’ve been sleeping throughout the night without having to make trips to bathroom. My vision is also more clear and not as cloudy, my gait is also better too. The last few days, I’ve been having a surge of energy too and I am just so grateful!”

There is low or minimal side effect of low dose naltrexone therapy. If it gives vivid dreams, I advise the patients to take it in the morning instead of the night. If you are about to get some operation or get anesthesia, it may reduce the effect of the anesthesia. Other than that, vast majority of patients do very well with it without little side effects.

I am grateful for this wonder drug.

Dr. An.

If your shoulder is constantly painful and stiff and you’ve experienced a reduction in your shoulder’s range of motion, you are most likely suffering from a condition known as adhesive capsulitis or “frozen shoulder”. Although you may know firsthand what frozen shoulder feels like, you may not know what causes this painful condition; first, some basic anatomy.

Basic Shoulder Anatomy

Your shoulder is made up of three bones: collarbone, shoulder blade, and upper arm bone (humerus). The round end of the humerus fits into a ball-and-socket joint and is surrounded by connective tissue. Synovial fluid enables the joint to move without friction. When scar tissues forms or the capsule that surrounds the joint experiences inflammation, scarring, thickening, or shrinkage, it can lead to frozen shoulder.

Possible Causes of Frozen Shoulder

The causes of frozen shoulder are not completely understood and an exact cause can’t always be identified, but most people suffering from the condition also experienced an injury of some sort. Possible causes can include:

  • Tendinitis (inflammation of your rotator cuff or biceps tendon)
  • Bursitis (inflammation of the fluid sacs between your joints)
  • Rotator cuff injury
  • Diabetes
  • Chronic inflammatory arthritis of the shoulder
  • Long-term immobility of the shoulder joint

Available Frozen Shoulder Treatment Options

The symptoms of adhesive capsulitis often develop gradually over time, but that doesn’t mean the condition isn’t extremely bothersome and painful. If you’re suffering from frozen shoulder or shoulder pain similar to it, now is the time to take advantage of available treatment options.

Here are some of the frozen shoulder treatments currently available:

  • Medications: Over-the-counter drugs such as ibuprofen and acetaminophen and prescription painkillers can help reduce inflammation and pain.
  • Compression packs: Hot or cold compression packs can also help reduce inflammation and pain.
  • Steroid shots: Corticosteroid injected into your shoulder joint helps alleviate pain and inflammation.
  • Transcutaneous electrical nerve stimulation (TENS): TENS numbs nerve endings in your spinal cord that control pain.
  • Shoulder manipulation: The practitioner gently moves your shoulder joint while you are under a general anesthetic.
  • Shoulder arthroscopy: This minimally invasive surgery is not as common as other treatments. A small endoscope, or tube, is inserted through a small incision to remove any scar tissue
  • Physical therapy/exercise: Specific exercises can help you maintain as much mobility and flexibility as possible without overworking or straining your shoulder.

Over-the-counter medication, compression packs, and exercise are the quickest and easiest frozen shoulder treatments and should be your first means of attacking that chronic shoulder pain.

If you’d like to try specific exercises to help reduce stiffness and pain, try the ones listed below. As your symptoms improve, start adding rotator cuff-strengthening exercises to the mix.

NOTE: Make sure you warm up that shoulder before beginning any exercise and don’t stretch to the point of pain.

Frozen Shoulder Exercises

Pendulum Stretch
Stand up and lean over slightly. Let the affected arm hang down. Swing the arm in a circle about 12 inches in diameter. Do 12 rotations in each direction every day. As your shoulder starts feeling better, increase the diameter of your circle. You can also hold a light weight (three to five pounds) in your hand.

Towel or Band Stretch
Grab a towel with both hands behind your back (holding it horizontally). Use your good arm to pull the towel up and to the side until you feel a stretch. Hold the stretch for 5 seconds and repeat 3 to 5 times a day. When your symptoms improve, you can drape the towel over your good shoulder, hold the bottom of it with your affected arm, and use your good arm to pull it up the lower back.

Cross-Body Stretch
Do this stretch sitting or standing. Use your good arm to lift your other arm at the elbow, bringing it up and across your body. Gently apply pressure to stretch your shoulder and hold for 15 to 20 seconds. Repeat this stretch 3 to 5 times a day.

Overhead Raise
Lie on your back with your head on a pillow. Hold the wrist of your affected arm with your other hand, thumbs pointed up. Gently lift your affected arm over your head as far as is comfortable. Hold for 5 seconds and repeat for 1 minute. Repeat this exercise 3 to 5 times a day.

An estimated 116 million people in the United States live with chronic pain. The leading cause of disability worldwide is chronic back pain, with head or neck pain, arthritis, nerve damage and cancer pain following close behind. If you’re in pain, you’ll want to know how to talk to your doctor about chronic pain symptoms.

Unfortunately, there isn’t a pain scale—like a blood pressure monitor—doctors can use to diagnose pain. While talking to your healthcare provider about chronic pain can be difficult, it is a conversation worth having. Healthcare providers will not know the location, timing, or intensity of your pain, unless you tell them.

 

What to Discuss at Your Next Appointment

Being specific is important for diagnostic purposes. Doing everything in your power to explain your pain clearly and accurately gives you the best chances of being heard and treated appropriately. Create a list of the questions you want answered and review the list before your appointment. Revise to form the three top questions you want answered. You may want to practice asking the questions with another person to test their clarity. If possible, include words that reflect what you want identified above.

Be assertive, but don’t blame healthcare providers. They cannot feel your pain, so you need to communicate clearly and work together for a solution. If your questions are not answered, ask for a follow-up appointment or email to get the answers you seek. Referrals to other providers may be needed to help you think, feel, and do as well as possible despite ongoing pain.

Help your care provider help you by writing down the description, location, and intensity of your pain along with whether it has changed or changes over time. Bring those descriptions and how pain affects your daily activities along with the three most important questions you want to ask your medical provider to your appointment.

If possible, point to the pain. If your pain moves around, tell your doctor all areas that can be painful and the areas that hurt most often. Your doctor needs to determine if the pain is chronic; it comes on more slowly and sticks around for a long time before slowly fading away or lessening, or paroxysmal; it comes on suddenly and sporadically, then leaves just as suddenly.

 

What do You Want From Your Doctor?

Do you want analysis? Do you expect to have tests run to diagnose a cause? Talk about those. Have you doctor explain what the tools and tests are and why they would help.

Do you want information? Do you already know the cause and just want more information about your condition? Be up front with your doctor about your curiosity and questions.

What causes my chronic pain? Have your doctor explain why your condition causes your chronic pain. Understanding the condition can assist in anticipating triggers.

Does my daily diet, exercise, or sleep pattern help or worsen the pain? Observe your daily routine and take notes. Let your doctor know if any changes to your routine alter your chronic pain symptoms.

What are the pros and cons of available treatments? Since there are multiple medications and therapies you want to have a thorough discussion with your physician about what’s the best way for you to manage your chronic pain. What helps one patient won’t necessarily help you. Make sure you feel confident during and after your appointment you’ve discussed the best treatment options.

Do you want reassurance? Express to your doctor early on whether or not you’d like them to stay with you during your diagnostic and treatment journey. Also if you believe that doctor just isn’t working out if your physician will recommend you getting a secondary or tertiary opinion about the causes of your chronic pain and your treatment plan.

Do you have existing chronic pain? Has pain relief opioids become something you’re considering? While they may be effective, they do come without risk. The CDC (Centers for Disease Control and Prevention) reports the U.S is in the middle of a opioid epidemic. There has not been a drastic increase in the amount of pain that Americans report. However, the amount of opioids prescribed and sold, for the goal of pain relief, has increased. Almost 218,000 people in the United States have died from prescription opioid related overdoses from year 1999-2017. Deaths from opioid overdoses were 5 times higher in 2017 than in 1999.

Even when prescribed and taken correctly, there’s a chance of developing a long-term dependence. Some feel like they don’t have a choice in whether to use opioids for their chronic pain. Fortunately, if you were hoping to avoid opioids for treating your pain, there are alternatives. Regenerative medicine is a method of treatments that focuses on using the body’s natural ability to heal in a more natural and drug free manner.

Regenerative medicine can help the body heal the underlying injury, alleviating pain. Opioids only relieve pain instead of treating the cause of the pain. Even not taking opioid addiction into consideration, opioids as a form of chronic pain relief may leave you with a long-term prescription that’ll be a constant expense. It’ll be an even longer expense if it develops into an addiction.

As well as being more natural, regenerative medicine aims to tackle the cause of pain instead of just relieving it. No possible addiction and no prescription with regenerative medicine treatments. Just healing the body with its own abilities.

Regenerative Medicine for pain Management

The two main forms of regenerative medicine is treatments containing stem cells and platelet rich plasma injections. Treatments containing stem cells involves injections using Wharton’s Jelly derived Mesenchymal stem cells. These treatments work because these treatments containing stem cells naturally have the ability to become specialized cells, helping the bodies healing process.

  • The regeneration of these tissues is one way regenerative medicine is able to treat pain that was formally more difficult to treat without drugs or surgery. An example of chronic pain that this would relieve is hip pain related to the depletion of the soft tissue at the joint of the hip. In this case, treatments containing stem cells would be used to regenerate this depleted soft tissue instead of just relieving the pain with opioids.
  • Platelet rich plasma injections is a procedure where blood is taken from the patient and then rapidly spun until plasma and platelets are separated. Platelets have healing properties within them that can repair damage within the body. These injections work because it introduces a concentrated amount of platelets at the site of an injury. Platelets are naturally a part of the body’s healing process, this procedure is concentrating them to where they are needed.

The aspect of regenerative medicine involves using the body’s natural healing abilities and concentrating them to where they are needed. Regenerative medicine doesn’t just relieve pain but treats underlying conditions in a surgical and drug free way.

Have you been using pain medication to cope with pain? For those suffering from chronic pain, medication can seem like one of those “necessary evils” to help you get through the day. However, use of painkillers, especially for an extended period of time, can have serious effects on your body and can truly do more harm than good. Let’s talk about how painkillers may not be the best option for treating pain.

Painkillers mask the issue

First and foremost, painkillers are a “Band-aid fix.” While they may provide temporary relief, they do not address the root of the issue. Without proper treatment for the underlying cause of your pain, you can get into a bad cycle of medicating. This can lead to further health problems and even addiction.

Long-term use of pain meds is ineffective for treating chronic pain

Many people suffering with chronic pain have been in pain for many years, sometimes even several decades. The body can actually become immune to the “painkilling” aspect over a long period of time. This can also lead to addiction as people tend to increase their dosage or self-medicate beyond what their doctor prescribed as they become immune to the effects. 

Painkillers come with serious side effects

Whether you’ve been taking pain medication for a few days or several years, there is a long list of side effects to be aware of, including addiction, increased risk of heart attack and stroke, risk of liver damage or ulcers, and more. 

Painkillers aren’t worth the risk

With so many pain management alternatives available, there is no need to continue popping painkillers. The use of (and potential addiction to) them is simply not worth the risk, not to mention that taking medication for damaged tissue or injury doesn’t address the issue it just masks it temporarily. Take your pain into your own hands and kick your pain medication habit to the curb with noninvasive, natural treatments such as stem cell therapy. 

You can learn more about alternative pain management options on our website. It’s time to stop relying on harmful painkillers and get down to the real problem so that you can truly heal and get back to living your life!

Following up on my last letter about CBD oil, I received several emails from patients telling me how they can’t try it because of their religious beliefs. I hope to clear some misunderstanding about CBD oil.

Marijuana as we know it contains 104 known chemical compounds. THC, tetrahydrocannabinol, is the main psychoactive compound responsible for giving people the “high” feeling. Another major compound, CBD (cannabidiol), is not associated with this “high feeling” and makes an appealing option for those suffering with chronic pain, anxiety and sleep problem. Think of a bottle of wine, and let’s say we extract alcohol out of the wine and just drink the grape juice. This is what CBD oil is like. CBD oil is all legal all across the country, you can drive and operate machinery, you are not going to get pulled over, and it’s highly unlikely that you will fail drug test.

Here are some benefits of CBD oil:

Helps with pain. There are many documented studies on how CBD oil helps with arthritic pain
and chronic pain. It also relieves cancer related pain.

Reduce anxiety and depression. CBD oil also has well documented results with reducing anxiety and depression and post traumatic stress disorder. The company I work with donates a bottle a month to veterans with PTSD. Also helps with sleep as well.

Reduce seizure activity and other neurological disorders. Several studies that documents CBD oil’s effectiveness on seizure reduction and neuroprotective activity on Alzheimer and Parkinson’s disease.

Other benefits include protection against heart disease, diabetes prevention, antipsychotic effects, but mostly we use in the office with some of our challenging patients with arthritis pain. I personally take a 1cc of CBD oil specially formulated for sleep. As with everything else, I wouldn’t recommend something to my patients I personally wouldn’t use.

We have a 7 day trial bottle of CBD oil for sale for $35. A small balm for topical application is also available for the same price. You can come by the office and pick it up. 832-460-6468.

If you are suffering from chronic pain, you may feel like surgery is your only option for relief. However, there are many noninvasive treatments that are just as effective as surgery at treating injuries and pain, if not more so. Before you decide to have surgery, you should understand the drawbacks of surgical treatment as well as consider the positive aspects of noninvasive treatments.

Here are five reasons to consider noninvasive treatments as an alternative to surgery:

1. Minimal recovery time

Surgery, especially a major one, can put you out of commission for weeks, or even months, while you recover. With noninvasive treatments such as stem cell therapy, the recovery time is minimal, and sometimes nonexistent. It is even possible to be back to your normal routine the day after noninvasive treatment!

2. Less risk

Any surgery has a certain amount of risk associated. You may experience complications after (or even during) the procedure that can extend or worsen your pain. Noninvasive treatments virtually eliminate risk.

3. Promotes natural, long-term healing

A surgical procedure may attempt to repair your damaged tissue or joints, but does not heal the body. Noninvasive regenerative medicine helps the body physically heal itself. This addresses the root of the problem, strengthens the problem area, and provides a long-term solution for your pain.

4. Cuts out the need for pain medication

Taking pain medication for pain can have serious pitfalls and side effects. If your pain is severe enough for you to be considering surgery, you have probably already taken your fair share of pain meds. It is likely that after surgery, you will need to be on painkillers during the recovery phases, which introduces all the risks associated with taking medication. Because stem cell therapy is noninvasive, you will not have to take pain medication following treatment.

5. Good alternative for high-risk groups

As mentioned, there are many risks associated with surgery. On top of that, some people have conditions that make surgery even more risky, or make it impossible. These people can still find relief from their pain with noninvasive treatments such as PRP or stem cell therapy.

To learn more about noninvasive treatment options, visit our website and make an appointment. Pain relief is possible without surgery, and we hope we can help you get back to a normal, pain-free life.