Annular Tears at T12–L1

An annular tear is a fissure or crack in the annulus fibrosus, the tough outer ring of an intervertebral disc. At the T12–L1 level—which marks the transition between your thoracic (mid-back) and lumbar (lower back) spine—these tears can occur due to age-related degeneration, sudden injury, or repetitive stress. When the annulus fibrosus is compromised, the inner gel-like nucleus pulposus may bulge or herniate through the tear, potentially irritating nearby nerve roots and causing pain, numbness, or weakness in the back and legs ncbi.nlm.nih.govtotalspineortho.com.

An annular tear is a crack or fissure in the tough outer ring (annulus fibrosus) of an intervertebral disc. At T12–L1—the junction between the last thoracic vertebra and the first lumbar vertebra—these tears can cause pain by allowing disc material or inflammatory chemicals to irritate nearby nerves or the spinal cord.

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Types of Annular Tears

1. Concentric (Circumferential) Tear
This tear runs parallel to the disc surface, splitting the layers of the annulus like pages in a book. It often results from repetitive twisting or bending.

2. Radial Tear
A radial tear begins in the soft inner core (nucleus) and extends outward toward the outer rim of the annulus. It can allow nucleus material to leak and inflame nearby tissues.

3. Peripheral (Rim) Tear
Located at the very outer edge of the annulus, a peripheral tear may involve the attachment between the annulus and the vertebral bone. It’s often linked to acute injury.

4. Transverse (Horizontal) Tear
This tear runs horizontally across the annulus, typically dividing the disc into upper and lower halves. It’s less common and often associated with severe trauma.

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Causes

1. Age-Related Degeneration
   As we get older, discs lose water and elasticity. This weakening makes the annulus more prone to cracking during normal movements.

2. Repetitive Bending and Twisting
   Jobs or activities that involve frequent bending or twisting strain the disc repeatedly, eventually causing tiny fissures.

3. Heavy Lifting
   Lifting objects incorrectly—especially overhead or with a rounded back—puts a sudden load on the T12–L1 disc and can tear the annulus.

4. Trauma or Falls
   A sudden impact, such as a fall from height or a car accident, can overwhelm the disc’s strength and cause a tear.

5. Axial Compression
   Direct vertical pressure on the spine—like landing hard on the feet—can squeeze the disc and crack its fibers.

6. Poor Posture
   Slouching or leaning forward for long periods shifts more stress onto the front of the disc, encouraging tears over time.

7. Obesity
   Extra body weight increases baseline pressure on all spinal discs, accelerating wear and tear.

8. Smoking
   Chemicals in cigarettes reduce blood flow to discs, hindering nutrition and healing of micro-injuries.

9. Genetic Predisposition
   Some people inherit weaker disc structure, making them more likely to develop tears under normal stress.

10. Disc Desiccation
    Loss of disc water content makes the annulus stiff and brittle, lowering its resistance to cracking.

11. Vibration Exposure
    Long-term use of vibrating tools (e.g., jackhammers, tractors) shakes the spine and can damage disc fibers.

12. High-Impact Sports
    Activities like gymnastics or football involve sudden compressive and twisting forces that can exceed disc strength.

13. Previous Spine Surgery
    Surgical disruption of nearby tissues may alter spinal mechanics, increasing stress at adjacent discs.

14. Steroid Use
    Long-term corticosteroids can weaken connective tissues, including the annulus fibrosus.

15. Diabetes Mellitus
    Poorly controlled diabetes impairs tissue repair and may accelerate disc degeneration.

16. Inflammatory Diseases
    Conditions like ankylosing spondylitis or rheumatoid arthritis can inflame and weaken disc structures.

17. Poor Nutrition
    Deficiencies in vitamins (e.g., C, D) or minerals (e.g., calcium) slow tissue repair and promote degeneration.

18. Dehydration
    Chronic low fluid intake reduces disc hydration and resilience, making tears more likely.

19. Occupational Repetitive Stress
    Assembly-line work or any job requiring repeated spinal flexion can cumulatively damage the annulus.

20. Congenital Spinal Anomalies
    Birth defects such as Schmorl’s nodes or vertebral malformations can alter load distribution and predispose to tearing.

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Symptoms

1. Localized Back Pain
   A sharp or aching pain at the lower thoracic/upper lumbar area, directly over T12–L1.

2. Pain with Twisting
   Turning the trunk often triggers a sudden jolt of pain where the annulus is torn.

3. Pain on Bending Forward
   Leaning forward increases pressure inside the disc, causing pain at the tear site.

4. Pain on Extension
   Leaning back can pinch the torn fibers and provoke discomfort.

5. Radiating Abdominal Pain
   Chemicals from the tear can irritate nearby nerves, causing pain that travels into the belly.

6. Stiffness
   Muscles around the tear can spasm, leading to a feeling of tightness in the mid-back.

7. Tenderness to Palpation
   Pressing on the skin over T12–L1 often reproduces or worsens the pain.

8. Pain with Coughing or Sneezing
   The sudden rise in spinal pressure during these actions jostles the tear and intensifies pain.

9. Night Pain
   Lying down can shift disc fluid and aggravate a tear, often waking patients at night.

10. Fatigue
    Chronic back pain can lead to overall tiredness and difficulty concentrating.

11. Muscle Spasm
    Protective tightening of surrounding muscles can feel like hard knots in the back.

12. Reduced Range of Motion
    Pain and stiffness make bending or twisting fully uncomfortable.

13. Numbness or Tingling
    Inflammatory substances may irritate nearby nerve roots, causing pins-and-needles sensations.

14. Weakness
    If a nerve root is irritated, the muscles it serves may feel weak.

15. Change in Gait
    Pain can alter the way a person walks, often leaning to one side.

16. Loss of Appetite
    Chronic pain sometimes reduces hunger and enjoyment of food.

17. Headache
    Muscle tension radiating upward can trigger tension-type headaches.

18. Balance Difficulties
    Discomfort may make shifting weight awkward, leading to unsteadiness.

19. Worsening with Prolonged Sitting
    Sitting increases pressure on T12–L1 and may flare the tear.

20. Relief with Lying Flat
    Removing weight from the spine by lying on a firm surface often eases pain briefly.

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Diagnostic Tests

A. Physical-Exam Tests

1. Inspection of Posture
   The doctor watches how you stand and sit to see if you hold yourself in ways that unload the painful segment.

2. Palpation for Tenderness
   Pressing gently along the spine pinpoints the exact spot of pain, suggesting an underlying tear.

3. Range of Motion Assessment
   You bend forward, backward, and side to side while the examiner notes how far you can move before pain begins.

4. Observation of Muscle Spasm
   Tight bands of muscle near the spine often accompany annular tears and can be felt under the skin.

5. Gait Analysis
   Walking with your shoes on, the doctor watches for limping or guarding that hints at spinal pain.

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B. Manual Provocative Tests

6. Kemp’s Test (Extension-Rotation)
   With you standing, the examiner gently extends and rotates your trunk; pain on the same side suggests a disc lesion.

7. Valsalva Maneuver
   Taking a deep breath and bearing down raises spinal pressure; worsening back pain points to an internal tear.

8. Slump Test
   Sitting on the table, you flex your head and spine; pain that radiates indicates nerve irritation near the tear.

9. Prone Instability Test
   Lying face down on the table’s edge, you raise your legs; relief of pain when legs are lifted suggests mechanical pain from the disc.

10. Adam’s Forward Bend Test
    Bending forward with feet together accentuates any asymmetry or segmental instability at the thoracolumbar junction.

11. Rib Spring Test
    The examiner presses and releases the ribs near T12; pain reproduction indicates segmental dysfunction.

12. Bechterew’s Test
    Similar to straight-leg raise but performed seated; pain or inability to extend the knee suggests nerve root irritation.

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C. Laboratory & Pathological Tests

13. Complete Blood Count (CBC)
    Useful to rule out infection or inflammation; most annular tears don’t show blood abnormalities.

14. Erythrocyte Sedimentation Rate (ESR)
    Elevated only if there’s an active inflammatory or infectious process, not with simple mechanical tears.

15. C-Reactive Protein (CRP)
    Like ESR, CRP rises with inflammation; a normal value supports a non-inflammatory tear.

16. HLA-B27 Testing
    Positive in some spondyloarthropathies; helps distinguish inflammatory disease from a purely mechanical tear.

17. Rheumatoid Factor (RF)
    Checks for rheumatoid arthritis, which can coexist but usually doesn’t cause isolated annular tears.

18. Antinuclear Antibody (ANA)
    Screens for connective-tissue diseases; a normal result points away from systemic conditions.

19. Serum Calcium
    High or low levels may suggest bone disorders that secondarily stress the disc.

20. Vitamin D Level
    Low vitamin D can impair bone and disc health, making tears more likely.

21. Blood Glucose
    Diabetes can slow tissue healing; this test ensures good metabolic control.

22. Blood Cultures
    Only if infection is suspected; a positive culture would point to discitis rather than a simple tear.

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D. Electrodiagnostic Tests

23. Nerve Conduction Studies
    Measure the speed of electrical signals in peripheral nerves; slowed conduction suggests nerve irritation.

24. Electromyography (EMG)
    Records muscle electrical activity; abnormal findings can localize a torn disc’s effect on a nerve root.

25. Somatosensory Evoked Potentials (SSEPs)
    Track sensory signal transmission from the body to the brain; delays may indicate spinal cord or nerve root compromise.

26. Motor Evoked Potentials (MEPs)
    Evaluate motor pathway integrity; changes suggest that disc chemicals may be affecting nerve conduction.

27. Paraspinal Mapping EMG
    Involves fine-wire electrodes placed along spinal muscles to pinpoint the affected segment.

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E. Imaging Tests

28. X-Ray: Anteroposterior (AP) View
    A front-to-back film shows vertebral alignment; cannot see the tear itself but may reveal disc height loss.

29. X-Ray: Lateral View
    Side view helps assess disc space narrowing at T12–L1, a clue to degeneration and possible tearing.

30. X-Ray: Oblique View
    Angled films highlight facet joints and posterior elements, useful to rule out other pathologies.

31. Flexion-Extension X-Rays
    Taken while bending forward and backward, these reveal abnormal motion at T12–L1 that may accompany tears.

32. Magnetic Resonance Imaging (MRI) T2-Weighted
    Shows fluid and soft tissues; a high-intensity zone (bright line) within the annulus is a hallmark of a tear.

33. MRI T1-Weighted
    Complements T2, providing detailed anatomy; helps distinguish between old and new tears.

34. MRI with Gadolinium Contrast
    Highlights areas of inflammation around a tear, making active fissures more visible.

35. Computed Tomography (CT) Scan
    Offers clear bone detail; can detect calcified tears or bony changes adjacent to the damaged annulus.

36. CT Myelography
    Involves injecting dye into the spinal canal before CT; outlines nerve roots and shows if leaking disc material presses on them.

37. Provocative Discography
    Dye is injected into the disc under pressure; reproduction of pain pinpoints the torn disc as the source.

38. CT Discogram
    Combines CT imaging with discography to map the exact location and extent of the tear in three dimensions.

39. Bone Scintigraphy (Bone Scan)
    Involves injecting a small amount of radioactive tracer; increased uptake at T12–L1 suggests active repair or inflammation.

40. Dual-Energy X-Ray Absorptiometry (DEXA)
    Measures bone density; low density may indicate osteoporosis that contributes to disc weakening.

Non-Pharmacological Treatments

Below are 30 conservative strategies—divided into four categories—that ease pain, promote healing, and restore function without medication. Each entry includes an elaborate description, its purpose, and its mechanism of action.

A. Physiotherapy & Electrotherapy

1. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Low-voltage electrical pulses applied via skin electrodes.

   • Purpose: Disrupt pain signals to the spinal cord and brain.

   • Mechanism: Activates large-fiber nerves to inhibit pain transmission in the dorsal horn.

2. Ultrasound Therapy

   • Description: High-frequency sound waves delivered to deep tissues.

   • Purpose: Enhance tissue healing and reduce inflammation.

   • Mechanism: Promotes micro-vibration and local blood flow, accelerating cell repair.

3. Spinal Traction

   • Description: Gentle mechanical stretching of the spine.

   • Purpose: Decompress intervertebral discs and relieve nerve pressure.

   • Mechanism: Creates negative pressure within the disc space, allowing retraction of herniated material.

4. Heat Therapy

   • Description: Application of moist heat packs to the lower back.

   • Purpose: Relax muscles, improve circulation, and alleviate stiffness.

   • Mechanism: Increases local tissue temperature, dilating blood vessels and reducing muscle spasm.

5. Cold Therapy (Cryotherapy)

   • Description: Icing the painful area for short periods.

   • Purpose: Decrease inflammation and numb pain.

   • Mechanism: Constricts blood vessels, reducing fluid accumulation and slowing nerve conduction.

6. Manual Therapy (Mobilization)

   • Description: Therapist-guided gentle joint movements.

   • Purpose: Restore normal joint mobility and alignment.

   • Mechanism: Applies graded forces to facet joints, improving motion and reducing pain receptors’ irritability.

7. Spinal Manipulation

   • Description: High-velocity, low-amplitude thrusts delivered by a chiropractor or physiotherapist.

   • Purpose: Realign vertebrae and relieve nerve compression.

   • Mechanism: Generates cavitation in joint fluid, resetting mechanoreceptors and reducing muscle tension.

8. Interferential Current Therapy (IFC)

   • Description: Two medium-frequency currents intersecting in the tissue.

   • Purpose: Deep pain relief with less skin discomfort.

   • Mechanism: Produces beat frequencies that penetrate deeper, stimulating pain-inhibitory pathways.

9. Laser Therapy (Low-Level Laser)

   • Description: Non-thermal light energy applied to tissues.

   • Purpose: Accelerate healing and reduce pain.

   • Mechanism: Stimulates mitochondrial activity, enhancing cellular repair and reducing inflammatory mediators.

10. Shockwave Therapy

    • Description: Focused acoustic pulses directed at the disc area.

    • Purpose: Break down scar tissue and promote angiogenesis.

    • Mechanism: Mechanical stress induces neovascularization and modulates inflammatory responses.

11. Diathermy (Short-Wave Therapy)

    • Description: Electromagnetic waves generating deep tissue heating.

    • Purpose: Loosen tight muscles and improve blood flow.

    • Mechanism: Converts electrical energy into heat, increasing metabolic activity in deep tissues.

12. Magnetic Field Therapy

    • Description: Pulsed electromagnetic fields applied over the spine.

    • Purpose: Enhance disc nutrition and cell repair.

    • Mechanism: Alters ion exchange across cell membranes, promoting anabolic processes.

13. Kinesio Taping

    • Description: Elastic therapeutic tape applied to skin over muscles.

    • Purpose: Support spinal muscles and reduce swelling.

    • Mechanism: Lifts skin microscopically, improving lymphatic drainage and proprioceptive feedback.

14. Intersegmental Mobilization Table

    • Description: A specialized table that oscillates spinal segments.

    • Purpose: Increase intervertebral mobility and reduce stiffness.

    • Mechanism: Rhythmic traction-compression cycles enhance nutrient exchange in discs.

15. Aquatic Therapy

    • Description: Exercises performed in a warm pool.

    • Purpose: Reduce gravitational stress and facilitate movement.

    • Mechanism: Buoyancy decreases load on the spine, allowing pain-free muscle activation.

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B. Exercise Therapies

1. Core Stabilization Exercises
   Strengthen deep abdominal and back muscles to support the spine and reduce disc pressure.

2. McKenzie Extension Protocol
   Repeated lumbar extensions that centralize pain and promote posterior disc retraction.

3. Flexion-Based Exercises
   Gentle forward bending and flexion movements to open posterior disc spaces and relieve tension.

4. Pilates-Based Stretching
   Low-impact movements focusing on spinal alignment, flexibility, and balanced muscle recruitment.

5. Segmental Muscle Activation
   Targeted exercises to isolate and strengthen specific stabilizers like multifidus and transversus abdominis.

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C. Mind-Body Therapies

1. Mindfulness Meditation
   Teaches non-judgmental awareness of pain sensations, reducing emotional stress and perceived intensity.

2. Yoga
   Combines physical postures with breathing and relaxation techniques to improve flexibility, strength, and mental resilience.

3. Tai Chi
   Slow flowing movements that enhance balance, core strength, and mind-body coordination.

4. Biofeedback
   Uses sensors to provide real-time feedback on muscle tension, helping patients learn to relax hyperactive back muscles.

5. Cognitive-Behavioral Therapy (CBT)
   Addresses negative thought patterns about pain, teaching coping strategies and activity pacing.

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D. Educational Self-Management

1. Pain Neuroscience Education
   Explains the biology of pain and disc healing, empowering patients to engage confidently in rehab.

2. Activity Pacing Training
   Teaches how to balance rest and activity to prevent flare-ups without avoiding movement entirely.

3. Ergonomic Back Care Instruction
   Guides on proper sitting, standing, and lifting techniques to minimize spinal stress.

4. Self-Monitoring Pain Diaries
   Encourages tracking pain triggers, patterns, and responses to treatments for data-driven adjustments.

5. Lifestyle & Weight Management Counseling
   Supports long-term spine health through diet, exercise, and healthy habits.

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Pharmacological Treatments

Below is a search-engine-optimized table of the most evidence-supported drugs for symptomatic annular tears. Each entry includes drug class, typical adult dosage, timing, and common side effects.

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Dietary Molecular Supplements

These supplements may support tissue health and modulate inflammation. Dosages are typical adult ranges; always confirm with a healthcare provider.

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Specialized Drug Therapies

These advanced treatments target bone density, regenerative healing, and joint lubrication. Dosages and functional roles vary by formulation and indication.

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Surgical Options

When conservative care fails, surgery may be indicated. Each procedure lists key steps and benefits.

1. Microdiscectomy

   • Procedure: Small incision; microscope-guided removal of herniated disc fragment.

   • Benefits: Rapid pain relief, minimal muscle disruption, shorter recovery.

2. Open Discectomy

   • Procedure: Standard incision; partial removal of ruptured disc.

   • Benefits: Direct visualization, effective nerve decompression.

3. Laminectomy

   • Procedure: Removal of lamina (roof of vertebral bone) to enlarge spinal canal.

   • Benefits: Relieves spinal stenosis, decreases nerve compression.

4. Laminotomy

   • Procedure: Partial removal of lamina to access herniation.

   • Benefits: Less bone removal, preserves stability.

5. Posterior Lumbar Interbody Fusion (PLIF)

   • Procedure: Disc space cleaned; bone graft and cage inserted; pedicle screws placed.

   • Benefits: Stabilizes spine, prevents recurrent tear.

6. Transforaminal Lumbar Interbody Fusion (TLIF)

   • Procedure: Unilateral approach for cage placement and fusion.

   • Benefits: Reduced neural retraction, faster fusion.

7. Artificial Disc Replacement

   • Procedure: Diseased disc removed; prosthetic disc implanted.

   • Benefits: Maintains motion, decreases adjacent-segment disease.

8. Endoscopic Discectomy

   • Procedure: Percutaneous endoscope removes disc material with minimal tissue damage.

   • Benefits: Tiny incisions, office-based possible, quick recovery.

9. Radiofrequency Ablation (RF Ablation)

   • Procedure: Heat generated at targeted nerve branch to interrupt pain signals.

   • Benefits: Minimally invasive, outpatient, long-lasting relief.

10. Spinal Cord Stimulator Implantation

    • Procedure: Electrodes placed epidurally; connected to subcutaneous pulse generator.

    • Benefits: Neuromodulation of pain pathways, adjustable intensity.

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Prevention Strategies

1. Maintain Healthy Weight: Reduces disc load and degeneration.

2. Regular Low-Impact Exercise: Swimming, walking to support spinal health.

3. Proper Lifting Technique: Bend at hips and knees, not waist.

4. Ergonomic Workstation: Chair with lumbar support; monitor at eye level.

5. Core Strengthening: Pilates or targeted workouts to stabilize spine.

6. Good Posture: Avoid slouching; use back-support cushions.

7. Quit Smoking: Enhances disc nutrition by improving blood flow.

8. Balanced Diet: Rich in calcium, vitamin D, protein for tissue repair.

9. Frequent Breaks: Avoid prolonged sitting; stand and stretch every 30–60 minutes.

10. Proper Sleep Support: Medium-firm mattress; pillow aligned to spine.

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When to See a Doctor

• Severe or Worsening Pain: Unrelieved by rest or medications.

• Neurological Signs: Numbness, tingling, or weakness in legs.

• Cauda Equina Warning: Saddle anesthesia, bowel/bladder changes—an emergency.

• Fever with Back Pain: Suggests possible infection.

• Trauma History: Recent accident or fall causing back pain.

• Unexplained Weight Loss: Could indicate systemic disease.

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Dos and Don’ts

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Frequently Asked Questions

1. What causes an annular tear at T12–L1?
   Annular tears can develop from natural aging, repetitive strain (e.g., heavy lifting), sudden trauma, or spinal degeneration that weakens the annulus fibrosus over time.

2. How is an annular tear diagnosed?
   MRI is the gold standard: tears appear as high-intensity zones on T2 images. Discography may be used to pinpoint pain sources if MRI is inconclusive.

3. Can annular tears heal on their own?
   Many minor tears repair gradually with conservative care—rest, physiotherapy, and pain management—though full tissue regeneration may take months.

4. Are annular tears always painful?
   No; up to 50% of adults have asymptomatic tears found incidentally on imaging. Pain arises when nerve-rich outer fibers are involved or herniation occurs.

5. What non-surgical treatments are most effective?
   Core stabilization exercises, TENS, and targeted manual therapy have strong evidence for pain reduction and functional improvement.

6. When is surgery recommended?
   If severe pain persists beyond 6–12 weeks of conservative care, neurological deficits develop, or there are signs of cauda equina syndrome.

7. Is disc herniation inevitable after an annular tear?
   Not always; many tears remain stable. Risk increases if the nucleus pulposus extrudes through a large radial tear.

8. Will I need lifelong pain medication?
   Most patients taper off medications as healing progresses. Long-term drug use is rare when rehabilitation is successful.

9. Can stem cell therapy repair an annular tear?
   Early studies show promise for mesenchymal stem cell injections to regenerate disc tissue, but broader clinical trials are ongoing.

10. How long does recovery take?
    With consistent therapy, many people see significant improvement in 8–12 weeks; full rehabilitation may extend to 6–12 months.

11. Are there lifestyle changes to prevent re-injury?
    Yes—maintaining core strength, practicing safe lifting, quitting smoking, and using ergonomic supports all lower recurrence risk.

12. Is weight loss helpful?
    Reducing excess body weight decreases spinal load, alleviating disc pressure and promoting healing.

13. Can supplements replace medications?
    Supplements support healing but are adjuncts—most patients still require short-term medication and therapy.

14. Will an annular tear show up on an X-ray?
    No; X-rays visualize bone, not soft tissue. MRI or CT myelogram is needed to detect tears.

15. What’s the long-term outlook?
    With appropriate care, many return to normal activities without surgery. Chronic issues can arise if tears progress or if risk factors persist.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: June 08, 2025.

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