PAIN EFFECTS:
PRP stands for PLATELET RICH PLASMA. In our blood, we have different cellular and plasma elements. Platelets are important parts of our blood that play a significant role in clot formation. Without them, bleedings would continue and a clot cannot be formed to stop bleeding.PRP
Another significant and important function of platelets is production of growth factors. Growth factors are elements in our body that would stimulate new growth of tissues. Many of pain conditions like chronic lower back pain, knee pain, shoulder or elbow pain are due to ligament or tendon injuries. Ligaments are responsible for connecting our bones together and Tendons are responsible for connecting our muscles to our bones. These are essential elements of stability in our Musculoskeletal system. When ligament or tendons are weakened or damaged, the damaged area can become unstable and cause pain. For example we have a joint in our lower back called Sacro-illiac joint. This is a connection between Sacrum and Iliac bones enforced by scaroilliac and other ligaments. This is a fixed joint which means in this area, the bones are not supposed to move and their stability in their position is essential for proper function. When the ligaments are damaged, this joint starts moving and causes a lot of pain. The feeling of “throwing your back out” is a casual expression of this joint instability.
PRP, when properly done, can expose the damaged ligaments and tendons to the growth factor of platelet rich plasma which is separated from blood by a special centrifuge machine. This would induce healing and strengthening in the damaged area. Strengthened ligaments and tendons would help stability and function as well as pain reduction.

COSMETIC EFFECTS:
Many of the facial skin aging effects are due to collagen damages. Collagen is one of the main elements in our connective tissue which holds the skin and other elements together. Sun light UV rays, our facial expressions, our genes, nutrition, smoking or many other factors may damage collagen and cause signs of aging on our face, neck or hand skin.PRP
It is believed that PRP can induce healing and cause new collagen production in the face, neck or hands skin. This would lead into skin tightening and reduction of skin aging signs.
It is also believed that the use of PRP can induce healing and slowing of thinning hair in hair loss and result in new hair growth. It is now an important part of hair restoration practices.
PRP is not a covered service and the average cost is between 500 to 750 dollars depending on the treated area and the amount used. This treatment is usually repeated three times to get the best effects. A significant portion of this fee is for the standard kit that is used for this procedure. Not using the standard kit would lead into less concentration of platelets and less favorable results.

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TRIGEMINALNEURALGIA

TRIGEMINAL NEURALGIA (TN) OR SUICIDE DISEASE:

TN is called "suicide disease" because there have been multiple reports of patients who committed suicide due to severity of this chronic neuropathic pain condition. TN is one of the most painful conditions known to us. It can happen without any reason known to us, or because of degeneration, viral infection or compression of Trigeminal nerve by a tumor or an artery. Dr. Harvey Cushing has demonstrated a rate of 0.6% mortality among 123 cases of TN that were followed during the time period of 1896 and 1912. This may sound very remote and we may assume that in this day and age there must be better treatments available and patients would not become so desperate to commit suicide. But the currently available treatments are not always effective.There are some medications (anti-epileptics)  or injections (nerve blocks) to calm the nerve. There are some other procedures to kill the trigeminal nerve or it's branches (injection of a liquid that would kill the nerve like: Glycerol, Phenol, Alcohol, etc.) or use radiation or surgery to cut the nerve or decompress the pressure from the close by tumor or artery (Gamma Knife radiation therapy or Microscopic Neurovascular decompression surgery). But the problem is that like any other neuropathic pain condition, once the nerve becomes crazy and starts to function abnormally, it may not be easy to calm it down. Even with cutting the nerve the pain may continue. Sometime injections may make the pain worse by causing more irritation for the nerve. When we talk about severe pain in this condition, we need to put things into proper perspective. Any slight touch, cold, heat, wind, chewing food or any other normal life activity may trigger such  a sever pain that the patient would become totally incapacitated due to pain. This is not your usual average or sever pain. This is truly something else. It's like having dental nerve surgery without anesthetic on a daily basis, or even worse than that.

Patient self management techniques and most importantly meditation can play a significant role in reducing the level of suffering from TN. It is very easy to forget all other good things that are going on with one's life due to this one terrible condition. Cognitive therapy exercises focusing on the value of all other positive aspects of one's life can reduce the risk of catastrophic outcomes like suicide for these patients. In my opinion we need more public education and awareness about this and other neuropathic pain conditions so these patients would not suffer the pain and loneliness at the same time.


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    To understand why are the pain patients irritable we can try a few things. We can try staying up very late or not even sleep for a few nights. We can try not to go to a few places we love the most for a while. We can try avoiding interacting with our loved ones. We can stop working for a while and deal with the financial issues that come with it. We can try to keep our weight down without being able to exercise. I am not going to suggest trying a bunch of different medications because we can't do it, but imagine having side effects of different medications like nausea, constipation, itchiness, dry mouth, impotence and depression added to the above picture. Now with having tried all of the above, try to keep a good attitude when dealing with the ongoing demands of our fast pace and needy world. We can try these for a while and see how difficult it is to keep our cool and be nice at all times. Now imagine if we have all of the above, all the time, with no end at our horizon to reach. We should be able to get the picture.  This is why the pain patients are irritable. This is not a comprehensive explanation, but it can give us an idea of what is going on with a pain patient's life.

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    What does hurt more? Our pain or being controlled by it?
    When every aspect of our life is being affected by pain, we live under the shadow of pain. Pain or any other problem in our life can take over our control. We are affected by it. It does change our ability to be who we are.
    We as humans have different abilities which are very interesting as some of them are opposite abilities. The same way that we have the ability for aggression, we are capable of submission as well. Many times we submit to the forces around us. But the worst battle we can lose in is submitting to the negative forces within us. Chronic pain or any other major problem for that matter can turn into catastrophe the moment we lose control to them. Now the real good news is:
    WE CAN TURN THE TABLE AROUND!
    Do you know why self management techniques like meditation, relaxation, guided imagery, cognitive therapy, etc. are so important and in many cases very effective? It is because You Gain Control. People who stand up to the daily fight of chronic pain know that none of these techniques really cure you of chronic pain, but all of them can help you to gain control of the situation instead of the situation stay in control. This turns the table and makes you as an observer of the situation, instead of being totally affected by it. Our views are different when we are  inside of a space or looking at it from above. The eagle eye vision is so effective because it is looking from above into the landscape and is not trapped inside it. We would feel much better when we feel our whole existence is not being controlled by anything but our own decision. We may still have the same level of pain, but we would certainly suffer much less than before.
    TURN THE TABLE, TAKE CONTROL.

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    Today is the best day of your life. Although you may still feel the heavy baggage of yesterday, it is nothing more than a memory. Yesterday does not exist anymore. Although you may worry about tomorrow, it is just a concept that your mind has made up. Tomorrow is not real right now. The only real day is today. When you face the wall of depression and think that you cannot go on any more, remind yourself of this reality: Today is the only real day and in this day, there are millions of people that would trade their spot on this planet with you in a split second if they could. So this is the best day of your life, the only real day, TODAY.

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    Pain medications are important tools in controlling pain. Their effects are different from one to another as they belong to different classes. However, they have different side effects as well. Each individual medication my have a side effect and once we take different ones together, their side effects may add up. Added to the pain medications, many of us are on multiple other medications for other conditions like blood pressure, anxiety, depression, asthma, etc. Each of those medications also have effects and side effects. Many of us see different physicians for different conditions and many times these doctors are not aware of each other's prescriptions. Each of these prescriptions have specific instructions from physicians about the doses and duration of prescription.
    The only place that has a pool of information about who we saw, what was prescribed to us, how much and for how long, is the pharmacy. Many times it is the pharmacy that can prevent life threatening drug interactions between different medications. There are some legal regulations about many medications, especially narcotics that would not allow early releases, double doctoring or multiple pharmacies for narcotic medications. Principally these regulations are not made to give us hard time. They are supposed to protect us and our pharmacists have to follow these regulations. In today's age of technology many things are done automatically. For example if we show up for the refill of a narcotic medication earlier than the doctor's instruction or if we have prescription from different doctors for narcotic medications the system would red flag our file. 
    This is why sometimes we feel our pharmacists are giving us hard time. I am not saying there re not some bad apples out there. Bad apples are everywhere, patients, doctors or pharmacists can be among them. But we need to know the facts before we pass the judgment on anyone.

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    It is very common that chronic pain patients complain of fatigue. Many pain patients are not able to carry on with their activities of daily life that many others conduct as a simple routine. These patients are often miss judged as lazy or inactive. They have to listen to lectures from all who may mean well about how they should be more active. It is very frustrating to be misunderstood. If you have chronic pain you would not be able to move well, you can't have a restful sleep and you are more likely than not, depressed. These are not different unrelated conditions. Each one feeds into another and the total sum will lead into less and less energy.
    Many of chronic fatigue conditions can start independent of pain by sources like a viral infection by EBV or a parasitic infestation of Lyme disease, etc. However once the fatigue settles in, most of the times chronic pain follows to appear due to mobility problems and body deconditioning. We lose muscles and develop poor posture when we are fatigued and inactive. Sleep, mood, hormonal and immune system disturbances can follow. One thing leads to another and make the clinical picture more and more complicated.
    The other aspect of this story is that many doctors do not know much about chronic fatigue, chronic pain and the inter play among them. We call them co-morbid conditions to give them a fancy name and ease the anxiety of unknown a bit, but most of us feel intimidated by the fact that we can't solve the problem we are facing.
    There are many conditions that we can cure, and some others that we can't cure but attempt to manage. No matter what the condition may be, dismissing and labeling the conditions as fake and patients as lazy are the worst ways of managing any condition. This does not mean that we should stop motivating patients to be as active as they can. Educating pain and fatigue patients about ways of exercise therapy for better self management outcomes is very helpful to them. Calling them lazy and dismissing their condition as unreal is not helpful at all.

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