Thoracic Disc Bulge at T4–T5

A thoracic disc bulge at T4–T5 occurs when the soft, cushion-like material inside the intervertebral disc between the fourth and fifth thoracic vertebrae pushes outward against the tougher outer layer. Unlike a herniation, which involves a rupture of the outer layer, a bulge means the disc’s shape is slightly distorted but the outer layer remains intact. This distortion can press on nearby spinal nerves or the spinal cord, leading to pain and other symptoms in the upper back, chest, or abdomen. Because the thoracic spine is less mobile than the neck or lower back, disc bulges here are less common but can still be disabling if left untreated.

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Types of Thoracic Disc Bulge

Central Bulge
A central bulge happens when the disc material pushes straight backward into the middle of the spinal canal. This may compress the spinal cord itself, potentially causing more widespread pain or balance issues if severe.

Paracentral Bulge
In a paracentral bulge, the disc protrudes just off-center, toward one side of the canal. This often affects the nerve roots exiting on that side, causing pain or tingling down the ribs or into the chest wall on one side.

Foraminal Bulge
A foraminal bulge occurs when the disc pushes into the foramen—the small opening where a nerve root leaves the spinal canal. This can pinch the exiting nerve, leading to sharp, shooting pain along that nerve’s path.

Lateral (Far Lateral) Bulge
A lateral or far-lateral bulge extends further out the side of the spine, outside the main canal. This can irritate the nerve as it travels down the ribcage or into the torso muscles, often causing localized sharp or burning pain.

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Causes

1. Aging
   Over time, discs naturally lose water and elasticity. This wear-and-tear makes them stiffer and more prone to bulging under normal loads.

2. Repetitive Strain
   Activities that repeatedly bend or twist the upper back—like certain manual jobs or sports—can gradually weaken the disc’s outer layer, encouraging a bulge.

3. Poor Posture
   Slouching or hunching forward for long periods increases pressure on the front of the discs, forcing them to bulge backward.

4. Trauma
   A sudden impact—such as a fall onto the back or a car accident—can cause immediate disc deformation or accelerate degeneration.

5. Genetics
   Some people inherit weaker disc structure, making them more prone to early bulging or degenerative changes.

6. Obesity
   Extra body weight places added stress on the spine, including the mid-back discs, which over time can lead to bulging.

7. Smoking
   Tobacco chemicals reduce blood flow to the discs, impairing their ability to repair and stay hydrated, thus making bulges more likely.

8. Sedentary Lifestyle
   Lack of regular movement weakens spinal muscles and reduces nutrient exchange in the discs, promoting degeneration and bulging.

9. Heavy Lifting
   Lifting objects with improper technique places extreme pressure on the discs, especially when twisting at the same time.

10. Vibrational Stress
    Prolonged exposure to whole-body vibration—such as driving heavy machinery—can fatigue disc fibers, leading to bulge formation.

11. Spinal Deformities
    Conditions like scoliosis or kyphosis unevenly distribute loads, causing excess pressure on certain discs including T4–T5.

12. Previous Spine Surgery
    Surgical changes can alter spine mechanics and accelerate degeneration at adjacent discs.

13. Inflammatory Diseases
    Disorders like ankylosing spondylitis can weaken disc structures through chronic inflammation.

14. Metabolic Disorders
    Diabetes and other conditions can affect disc nutrition and healing, leaving them more susceptible to bulging.

15. Nutritional Deficiencies
    Lack of key nutrients (vitamin D, calcium, protein) can impair disc maintenance and resilience.

16. Hormonal Changes
    Hormonal shifts, especially in menopause, can change tissue quality and disc hydration.

17. Occupational Hazards
    Jobs involving frequent overhead reaching or twisting can place repeated stress on thoracic discs.

18. Athletic Overuse
    Sports requiring constant upper-body rotation (golf, tennis) can fatigue the supporting structures, leading to bulges.

19. Connective Tissue Disorders
    Conditions like Ehlers–Danlos syndrome disrupt collagen strength, making discs easier to deform.

20. Age-Related Disc Desiccation
    As discs lose hydration naturally with age, they flatten and become more prone to outward bulging under everyday pressures.

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Symptoms

1. Upper Back Pain
   A dull ache centered around the T4–T5 level, often worsened by twisting or bending.

2. Sharp, Stabbing Pain
   Brief, intense pain that may shoot around the chest wall or between ribs when coughing or sneezing.

3. Radiating Pain
   Pain that travels from the spine around the torso in a band-like pattern, following the path of a compressed nerve.

4. Numbness
   A loss of feeling or “pins and needles” sensation along the path of the affected nerve, often on one side of the chest or back.

5. Tingling
   A prickling or “buzzing” sensation in the skin supplied by the irritated nerve root.

6. Muscle Weakness
   Unusual tiredness or weakness in the back muscles or chest wall, sometimes affecting posture or breathing effort.

7. Stiffness
   Reduced flexibility in bending or twisting the upper back, making certain movements painful or limited.

8. Spinal Tenderness
   Tenderness to touch or gentle pressure directly over the T4–T5 vertebrae.

9. Pain with Deep Breathing
   Discomfort or sharp pain when taking a deep breath, due to movement of the rib attachments near the bulge.

10. Increased Pain with Sitting
    Sitting slouched or unsupported can increase pressure on the bulging disc, exacerbating pain.

11. Pain with Standing
    Standing for long periods without movement may worsen pressure on the disc, leading to increased discomfort.

12. Postural Changes
    A noticeable hunch or rounded shoulders developing as the body shifts to avoid pain.

13. Loss of Balance
    In rare cases where the spinal cord is compressed centrally, balance and coordination may be affected.

14. Chest Discomfort
    A deep, aching feeling in the chest that might be mistaken for heart-related pain.

15. Abdominal Pain
    Pain or a dragging sensation in the upper abdomen if certain nerves are irritated.

16. Night Pain
    Pain that worsens when lying down, making it hard to find a comfortable sleeping position.

17. Activity-Related Flare-Ups
    Bouts of intense pain triggered by lifting, twisting, or prolonged activity.

18. Pain on Coughing or Sneezing
    Sudden increases in pressure inside the spine when coughing or sneezing can sharply aggravate the bulge.

19. Fatigue
    General tiredness from chronic pain and poor sleep due to discomfort.

20. Psychological Impact
    Anxiety or mood changes secondary to ongoing pain and reduced physical function.

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Diagnostic Tests

Physical Examination

1. Inspection of Posture
   The doctor observes how you stand and sit, looking for unusual curves or tilts that suggest pain-avoidance patterns.

2. Palpation
   Gentle pressing along the spine to locate areas of tenderness or tight muscles at T4–T5.

3. Range of Motion (ROM) Testing
   You’ll bend, twist, and arch your back to see which movements increase pain, helping localize the bulge.

4. Chest Expansion Measurement
   Measuring how far the ribs move during breathing can reveal pain-limiting chest wall motion.

5. Percussion Test
   Tapping over the spine gently; increased pain can indicate inflammation near the disc.

6. Neurological Screening
   Checking reflexes, strength, and sensation in the arms, torso, and legs to spot any nerve involvement.

Manual Provocative Tests

7. Kemp’s Test
   While standing, you extend, rotate, and laterally bend the spine; reproduction of pain suggests a disc problem in the tested region.

8. Thoracic Compression Test
   Firm downward pressure on the shoulders tests for increased pain at the suspected disc level.

9. Adam’s Forward Bend Test
   Bending forward highlights any uneven rib or spine alignment from muscle guarding around a bulge.

10. Valgus Stress on Ribs
    Gently pushing the ribs sideways can reproduce nerve pain referred from T4–T5.

11. Slump Test
    Seated with a slumped posture, you extend one knee; shooting pain can signal neural tension from a bulging disc.

Lab and Pathological Tests

12. Complete Blood Count (CBC)
    Assesses overall health and checks for infection signs that could mimic disc pain.

13. Erythrocyte Sedimentation Rate (ESR)
    Measures how quickly red blood cells settle; elevated levels suggest inflammation or infection.

14. C-Reactive Protein (CRP)
    A blood marker that rises in inflammation, helping rule out inflammatory spine diseases.

15. Rheumatoid Factor
    Tests for autoimmune conditions that can cause spine pain similar to disc bulges.

16. HLA-B27 Test
    Genetic marker associated with ankylosing spondylitis, which may mimic bulge symptoms.

Electrodiagnostic Tests

17. Electromyography (EMG)
    A thin needle records electrical activity in muscles to see if nerves at T4–T5 are affected.

18. Nerve Conduction Velocity (NCV)
    Small electrical pulses test how fast signals travel along nerves emerging at the bulge level.

19. Somatosensory Evoked Potentials (SSEP)
    Measures how well sensory signals travel through the spinal cord from limbs to the brain.

20. Motor Evoked Potentials (MEP)
    Tests signal transmission along motor pathways through the spinal cord to check for compression effects.

21. F-Wave Study
    Looks at late responses in nerve testing to detect subtle nerve root irritation from a bulge.

Imaging Tests

22. Plain X-Ray (PA and Lateral)
    Quick first step to rule out fractures or significant alignment issues; discs themselves aren’t seen but spaces narrow if degenerated.

23. Flexion-Extension Radiographs
    X-rays taken at end-range bending to see if any abnormal motion occurs at T4–T5.

24. Magnetic Resonance Imaging (MRI)
    The gold standard for visualizing disc shape, spinal cord, and nerve roots in fine detail without radiation.

25. Computed Tomography (CT) Scan
    Provides clear images of bone and calcified discs; helpful if MRI is contraindicated.

26. CT Myelogram
    Dye is injected into the spinal fluid before CT scanning, highlighting areas where the disc bulge presses on nerves.

27. Discography
    Dye injected into the disc under pressure reproduces pain; helps confirm that T4–T5 is the pain source.

28. Myelography
    Similar to CT myelogram but followed by plain X-rays, useful when MRI isn’t possible.

29. Bone Scan (Technetium-99m)
    Highlights areas of high bone turnover, ruling out tumors or infection that mimic bulge symptoms.

30. Ultrasound of Paraspinal Muscles
    Assesses muscle health and inflammation around the thoracic spine, supporting the diagnosis of related muscle pain.

Non-Pharmacological Treatments

Physiotherapy & Electrotherapy Therapies

1. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Mild electrical currents delivered via skin electrodes.

   • Purpose: To reduce pain signal transmission.

   • Mechanism: Activates inhibitory interneurons in the dorsal horn, blocking nociceptive input Physiopedia.

2. Therapeutic Ultrasound

   • Description: High-frequency sound waves applied with a gel-coupled probe.

   • Purpose: Promotes tissue heating and repair.

   • Mechanism: Enhances collagen extensibility, increases local blood flow, and accelerates healing Physiopedia.

3. Cold Therapy (Cryotherapy)

   • Description: Application of ice packs to the mid-back region.

   • Purpose: To decrease acute inflammation and pain.

   • Mechanism: Vasoconstriction reduces tissue edema and slows nociceptor activity Physiopedia.

4. Heat Therapy (Thermotherapy)

   • Description: Use of hot packs or heating pads.

   • Purpose: Relief of muscle tension and stiffness.

   • Mechanism: Vasodilation increases nutrient delivery, relaxes muscles, and modulates pain receptors Physiopedia.

5. Spinal Mobilization

   • Description: Hands-on gentle oscillatory movements of the thoracic spine.

   • Purpose: Restore normal joint kinematics.

   • Mechanism: Stimulates mechanoreceptors, reduces joint stiffness, and interrupts pain cycles Physiopedia.

6. Spinal Manipulation

   • Description: High-velocity, low-amplitude thrusts.

   • Purpose: Quickly restore segmental motion.

   • Mechanism: Produces cavitation, sustains analgesic effect via neurophysiological pathways Physiopedia.

7. Mechanical Traction

   • Description: Intermittent stretching of the thoracic spine on a traction table.

   • Purpose: Decompress intervertebral spaces.

   • Mechanism: Reduces disc pressure, increases nutrient exchange, and alleviates nerve root compression Wikipedia.

8. Soft Tissue Massage

   • Description: Manual kneading and stroking of paraspinal muscles.

   • Purpose: Relieve myofascial trigger points.

   • Mechanism: Increases circulation, reduces muscle tone, and promotes endorphin release Physio.

9. Electrical Muscle Stimulation (EMS)

   • Description: Low-frequency electrical currents to elicit muscle contractions.

   • Purpose: Prevent muscle atrophy and improve tone.

   • Mechanism: Stimulates alpha-motor neurons to strengthen stabilizing musculature Physiopedia.

10. Interstitial Thermal Therapy

    • Description: Deep heating via short-wave diathermy.

    • Purpose: Reach deeper tissues than superficial heat.

    • Mechanism: Induces vasodilation and metabolic activity in deep muscle and disc tissues Physiopedia.

11. Low-Level Laser Therapy (LLLT)

    • Description: Non-thermal light application.

    • Purpose: Promote tissue repair and analgesia.

    • Mechanism: Photobiomodulation increases mitochondrial activity and reduces inflammation Physiopedia.

12. Pulsed Electromagnetic Field (PEMF)

    • Description: Time-varying magnetic fields delivered via coils.

    • Purpose: Enhance fusion post-surgery and reduce pain.

    • Mechanism: Stimulates cellular repair pathways and modulates inflammatory mediators Physiopedia.

13. Kinesio Taping

    • Description: Elastic therapeutic tape applied along paraspinal muscles.

    • Purpose: Improve posture and proprioception.

    • Mechanism: Lifts skin to reduce pressure, stimulate mechanoreceptors, and support soft tissues Physiopedia.

14. Ultrasound-Guided Dry Needling

    • Description: Insertion of fine needles into trigger points.

    • Purpose: Release myofascial tension.

    • Mechanism: Evokes local twitch response, resets muscle spindle activity, and reduces pain Physiopedia.

15. Biofeedback Training

    • Description: Real-time feedback on muscle activation.

    • Purpose: Enhance voluntary control of deep stabilizers.

    • Mechanism: Teaches relaxation and targeted activation of the transversus thoracis and erector spinae Physiopedia.

Exercise Therapies

16. Thoracic Extension Exercises

    • Description: Seated foam-roll extensions over T4–T5.

    • Purpose: Improve segmental mobility and posture.

    • Mechanism: Stretches anterior annulus and strengthens erector spinae to counteract flexion forces Barrow Neurological Institute.

17. Scapular Retraction Drills

    • Description: Band-resisted rows focusing on mid-trapezius.

    • Purpose: Support thoracic alignment.

    • Mechanism: Strengthens scapular stabilizers to unload the thoracic spine physicaltherapyspecialists.org.

18. Deep Breathing with Rib Expansion

    • Description: Diaphragmatic breathing with lateral rib flare.

    • Purpose: Enhance thoracic mobility and reduce muscle guarding.

    • Mechanism: Mobilizes costovertebral joints and promotes relaxation NCBI.

19. Thoracic Rotation Stretches

    • Description: Supine trunk rotations with knees bent.

    • Purpose: Restore rotational range of motion.

    • Mechanism: Gentle traction across the disc and facet joints to reduce adhesions Annals of Rehabilitation Medicine.

20. Prone Cobra Raises

    • Description: Lifting chest off plinth with shoulders retracted.

    • Purpose: Activate thoracic paraspinals and lower traps.

    • Mechanism: Promotes dynamic support of posterior elements, reducing disc load Centeno-Schultz Clinic.

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Pharmacological Treatments (Drugs)

Note: Always individualize dosing based on comorbidities and renal/hepatic function.

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Dietary Molecular Supplements

1. Glucosamine Sulfate (1,500 mg/day)

   • Function: Supports cartilage synthesis.

   • Mechanism: Precursor for glycosaminoglycan formation; anti-inflammatory effects.

2. Chondroitin Sulfate (1,200 mg/day)

   • Function: Maintains disc matrix integrity.

   • Mechanism: Inhibits cartilage-degrading enzymes and cytokines.

3. Omega-3 Fatty Acids (1,000 mg EPA/DHA daily)

   • Function: Systemic inflammation modulation.

   • Mechanism: Shifts eicosanoid balance toward anti-inflammatory prostaglandins.

4. Vitamin D₃ (1,000–2,000 IU/day)

   • Function: Bone health and neuromuscular function.

   • Mechanism: Regulates calcium homeostasis and muscle strength.

5. Curcumin (500–1,000 mg/day)

   • Function: Potent anti-inflammatory.

   • Mechanism: Inhibits NF-κB and COX-2 pathways.

6. MSM (Methylsulfonylmethane) (1,500 mg/day)

   • Function: Joint comfort support.

   • Mechanism: Donates sulfur for connective tissue repair.

7. Boswellia Serrata Extract (300 mg TID)

   • Function: Reduces pain and inflammation.

   • Mechanism: Inhibits 5-lipoxygenase and leukotriene synthesis.

8. Hyaluronic Acid (80 mg/day orally)

   • Function: Improves synovial fluid viscosity.

   • Mechanism: Lubricates joints, reduces friction.

9. Collagen Peptides (10 g/day)

   • Function: Supports disc annulus structure.

   • Mechanism: Provides amino acids for matrix protein assembly.

10. Resveratrol (150 mg/day)

• Function: Antioxidant and anti-inflammatory.

• Mechanism: Activates SIRT1, reduces oxidative stress.

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Advanced & Regenerative Drug Therapies

1. Alendronate (Bisphosphonate) 70 mg PO weekly

   • Function: Prevents bone resorption.

   • Mechanism: Inhibits osteoclast-mediated bone turnover.

2. Zoledronic Acid 5 mg IV annually

   • Function: Strengthens vertebrae.

   • Mechanism: Potent osteoclast apoptosis inducer.

3. Platelet-Rich Plasma (PRP) Injections

   • Function: Stimulates disc repair.

   • Mechanism: Delivers growth factors (PDGF, TGF-β) to disc nucleus.

4. Hyaluronic Acid Viscosupplementation

   • Function: Enhances disc hydration.

   • Mechanism: Maintains disc osmotic pressure and nutrient diffusion.

5. Autologous Stem Cell Therapy

   • Function: Regenerates nucleus pulposus.

   • Mechanism: Mesenchymal stem cells differentiate into chondrocyte-like cells.

6. BMP-7 (Osteogenic Protein-1)

   • Function: Promotes disc matrix synthesis.

   • Mechanism: Stimulates proteoglycan and collagen II production.

7. Cartilage-Derived Morphogenetic Protein (CDMP)

   • Function: Encourages disc cell proliferation.

   • Mechanism: Acts on BMP receptors to upregulate matrix genes.

8. Thymosin β4

   • Function: Enhances tissue healing.

   • Mechanism: Modulates inflammation and angiogenesis.

9. Injectable Hydrogel Scaffolds

   • Function: Provides structural support to nucleus.

   • Mechanism: Mimics native disc matrix, promoting cell infiltration.

10. Gene Therapy Vectors (e.g., TGF-β1 plasmid)

    • Function: Sustained growth factor delivery.

    • Mechanism: Transfects disc cells to overexpress anabolic cytokines.

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Surgical Options

1. Thoracic Discectomy

   • Procedure: Posterior removal of bulging disc fragment.

   • Benefits: Immediate nerve decompression.

2. Microendoscopic Discectomy

   • Procedure: Minimally invasive resection via tubular retractor.

   • Benefits: Less tissue trauma, faster recovery.

3. Thoracic Fusion (Posterolateral)

   • Procedure: Disc removal + bone graft + instrumentation.

   • Benefits: Stabilizes segment, prevents recurrence.

4. Anterior Transthoracic Discectomy

   • Procedure: Chest-approach removal of central bulge.

   • Benefits: Direct ventral decompression.

5. Video-Assisted Thoracoscopic Surgery (VATS)

   • Procedure: Endoscopic anterior approach.

   • Benefits: Reduced pulmonary morbidity.

6. Thoracic Corpectomy

   • Procedure: Resection of vertebral body + disc.

   • Benefits: Addresses extensive pathology, reconstructs column.

7. Percutaneous Endoscopic Thoracic Discectomy

   • Procedure: Needle-guided endoscopic fragment removal.

   • Benefits: Local anesthesia, rapid mobilization.

8. Interbody Cage Placement

   • Procedure: Spacer insertion after disc removal.

   • Benefits: Maintains disc height and alignment.

9. Subtotal Facetectomy

   • Procedure: Partial facet removal for access.

   • Benefits: Better visualization, indirect decompression.

10. Dynamic Stabilization (e.g., Dynesys)

    • Procedure: Pedicle-based flexible rod system.

    • Benefits: Allows controlled motion, offloads disc.

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Prevention Strategies

1. Maintain neutral spine posture during sitting

2. Use ergonomic chairs with thoracic support

3. Practice safe lifting with legs, not back

4. Engage in regular thoracic mobility exercises

5. Keep core musculature strong

6. Avoid prolonged static postures

7. Warm up before sports or heavy lifting

8. Maintain healthy body weight

9. Wear supportive footwear

10. Use backpacks with dual straps and waist belt

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When to See a Doctor

• Persistent pain despite 4–6 weeks of conservative care

• Neurological signs: numbness, tingling, or weakness in trunk or limbs

• Bladder/bowel changes or gait disturbances

• Severe, unrelenting pain at rest or night pain

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Lifestyle Recommendations: Dos & Don’ts

• Do: Practice daily posture checks, take frequent breaks from sitting, apply cold/heat alternately.

• Don’t: Slouch, lift heavy objects unsupported, ignore early warning signs, sleep on non-supportive mattresses.

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Frequently Asked Questions

1. What causes thoracic disc bulging at T4–T5?
   Age-related degeneration, poor posture, repetitive strain, or trauma can weaken the annulus, leading to bulging.

2. Is a T4–T5 bulge the same as a herniation?
   A bulge involves uniform protrusion of the disc margin, whereas a herniation is focal nucleus extrusion.

3. Can non-surgical treatments fully resolve symptoms?
   Yes, most patients improve with conservative care including physiotherapy and medication.

4. How long does recovery take without surgery?
   Typically 6–12 weeks for significant pain relief and functional gains.

5. Is MRI necessary for diagnosis?
   MRI confirms disc pathology and rules out other causes like tumors or fractures.

6. Do I need bed rest?
   Short rest (1–2 days) may help acute pain, but prolonged bed rest delays recovery.

7. Are injections helpful?
   Epidural steroid injections can provide temporary relief but are adjuncts to rehabilitation.

8. Will the bulge get worse over time?
   With proper management, progression can be prevented; without care, degeneration may continue.

9. Can I still exercise?
   Yes—guided, low-impact exercises strengthen supporting muscles and improve mobility.

10. Is surgery risky?
    All surgeries carry risks; minimally invasive approaches have lower complication rates.

11. Can supplements replace medication?
    Supplements support joint health but often require combination with pharmacotherapy.

12. Will I fully regain mobility?
    Most regain near-normal function with structured rehab; severe cases may have residual stiffness.

13. What ergonomic changes help?
    Adjust chair height, use lumbar-support cushions, position monitors at eye level.

14. How can I manage flare-ups at work?
    Use alternating cold/heat, take micro-breaks, perform gentle stretches hourly.

15. When is fusion recommended?
    For unstable segments, recurrent bulges, or when conservative care fails, fusion may stabilize the spine.\

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: May 30, 2025.

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