Thoracic Transverse Nerve Root Lateral Compression

Thoracic transverse nerve root lateral compression, also known as thoracic radiculopathy, occurs when one or more of the nerves that exit the thoracic spine become pinched or squeezed as they travel laterally through the intervertebral foramen. This compression irritates the nerve root, leading to pain, numbness, or weakness in the chest or abdominal wall following a dermatomal pattern. Although less common than cervical or lumbar nerve root compression, thoracic involvement can cause significant discomfort and functional limitations now.aapmr.orgpmc.ncbi.nlm.nih.gov.

The thoracic spine consists of 12 vertebrae (T1–T12), each giving rise to a pair of nerve roots. These nerve roots exit the spinal canal through lateral openings called foramina. In a healthy spine, the nerve roots pass freely; in lateral compression, surrounding structures—such as intervertebral discs, facet joints, or bone spurs—crowd the foramen, squeezing the nerve root against the transverse processes or vertebral bodies hopkinsmedicine.org.

When a thoracic nerve root is compressed:

• Mechanical deformation disrupts the nerve’s blood supply, leading to localized ischemia.

• Inflammatory mediators (e.g., cytokines) accumulate, causing swelling and sensitization of the nerve.

• Ectopic nerve firing produces radicular pain signals that follow the sensory distribution of the affected nerve.

Over time, sustained compression can result in demyelination or axonal injury, worsening symptoms and potentially causing muscle weakness in the corresponding myotome.

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Non-Pharmacological Treatments

Below are evidence-based non-drug therapies, organized into four categories. Each entry includes a simple-language description, its purpose, and how it works.

Physiotherapy and Electrotherapy Therapies

1. Heat Therapy
   Applying warm packs or heated pads to the mid-back.
   Purpose: Relieve muscle tension and reduce pain.
   Mechanism: Heat dilates blood vessels, increasing circulation and relaxing tight muscles.

2. Cold Therapy (Cryotherapy)
   Using ice packs wrapped in cloth on the painful area.
   Purpose: Decrease inflammation and numb sharp pain.
   Mechanism: Cold constricts blood vessels, reducing swelling and slowing nerve signals.

3. Ultrasound Therapy
   Applying sound-wave energy via a handheld device.
   Purpose: Promote tissue healing and reduce deep muscle spasms.
   Mechanism: Microscopic vibrations increase local blood flow and cell membrane permeability.

4. Transcutaneous Electrical Nerve Stimulation (TENS)
   Placing electrodes near the compression site to deliver mild electrical pulses.
   Purpose: Block pain signals and stimulate endorphin release.
   Mechanism: Electrical currents override pain nerve signals, activating natural pain blockers.

5. Interferential Current Therapy
   Using two medium-frequency currents that intersect within the tissue.
   Purpose: Alleviate deeper-seated pain and muscle stiffness.
   Mechanism: Beat frequencies produce low-frequency stimulation at depth without skin discomfort.

6. Diathermy (Shortwave)
   Employing electromagnetic waves to heat deeper tissues.
   Purpose: Accelerate healing and reduce pain.
   Mechanism: High-frequency fields cause molecular friction, warming muscles and connective tissue.

7. Laser Therapy (Low-Level)
   Shining cold laser light on the affected area.
   Purpose: Reduce inflammation and encourage nerve repair.
   Mechanism: Photons enhance mitochondrial activity, boosting cellular energy and healing.

8. Shockwave Therapy
   Delivering high-pressure acoustic waves to the spine.
   Purpose: Break down scar tissue and stimulate regeneration.
   Mechanism: Mechanical pulses promote angiogenesis and collagen remodeling.

9. Spinal Mobilization
   A physiotherapist uses gentle rhythmic movements on the spine.
   Purpose: Improve joint mobility and relieve nerve impingement.
   Mechanism: Small oscillations stretch the joint capsule and reduce pressure on the nerve.

10. Spinal Manipulation
    Quick, targeted thrusts on the vertebrae by a skilled therapist.
    Purpose: Restore normal joint motion and decrease pain.
    Mechanism: A rapid stretch of joint structures can release entrapped synovial fluid and reduce nerve pressure.

11. Traction Therapy
    Applying a controlled pulling force to the thoracic spine.
    Purpose: Increase foraminal space and relieve nerve compression.
    Mechanism: Sustained or intermittent traction separates vertebrae slightly, reducing intradiscal pressure.

12. Hydrotherapy (Aquatic Therapy)
    Performing gentle movements in a warm pool.
    Purpose: Support exercise without strain and improve circulation.
    Mechanism: Buoyancy reduces load on the spine, while warmth relaxes muscles.

13. Kinesio Taping
    Elastic tape applied along the spine in specific patterns.
    Purpose: Provide support, reduce swelling, and improve posture.
    Mechanism: Lifts the skin microscopically to enhance lymphatic drainage and proprioception.

14. Therapeutic Massage
    Hands-on kneading and gliding strokes by a massage therapist.
    Purpose: Relieve muscle knots, improve blood flow, and reduce stress.
    Mechanism: Mechanical pressure stretches and relaxes muscle fibers, releasing tension.

15. Myofascial Release
    Sustained pressure on tight fascia and connective tissue.
    Purpose: Restore mobility between muscle layers and ease nerve irritation.
    Mechanism: Slow stretching breaks adhesions in the fascia, improving glide and reducing pressure on nerves.

Exercise Therapies

16. Core Stabilization Exercises
    Gentle activation of abdominal and back muscles (e.g., drawing-in maneuver).
    Purpose: Support the spine and prevent excessive movement.
    Mechanism: Strengthening deep stabilizers distributes load away from compressed nerve roots.

17. Thoracic Extension Exercises
    Simple backward bends over a foam roller.
    Purpose: Open up the thoracic foramen and stretch tight front-of-spine structures.
    Mechanism: Extension increases foraminal area, reducing mechanical pressure on the nerve.

18. Flexibility and Stretching
    Targeted stretches for pectoral, latissimus, and spinal muscles.
    Purpose: Improve overall range of motion and posture.
    Mechanism: Lengthening muscle fibers reduces strain on vertebral joints.

19. Yoga
    Poses emphasizing gentle backbends and core control (e.g., cobra pose).
    Purpose: Combine flexibility, strength, and mindfulness.
    Mechanism: Slow movements and breathing calm the nervous system and support spinal alignment.

20. Pilates
    Low-impact routines focusing on control, breathing, and posture.
    Purpose: Enhance muscular balance and spinal support.
    Mechanism: Coordinated muscle activation stabilizes the spine and reduces aberrant forces on nerve roots.

Mind-Body Therapies

21. Mindfulness Meditation
    Guided practice of nonjudgmental awareness of thoughts and sensations.
    Purpose: Decrease pain perception and stress.
    Mechanism: Alters brain pain pathways, raising pain threshold and reducing emotional distress.

22. Biofeedback
    Using sensors to monitor muscle tension and learn relaxation techniques.
    Purpose: Control muscle guarding and associated pain.
    Mechanism: Real-time feedback lets patients consciously relax overactive muscles.

23. Cognitive Behavioral Therapy (CBT)
    Talking with a therapist to reshape negative pain-related thoughts.
    Purpose: Improve coping strategies and reduce pain-related anxiety.
    Mechanism: Changing thought patterns lowers stress hormones that amplify pain signals.

24. Guided Imagery
    Visualization exercises imagining soothing scenarios.
    Purpose: Distract from pain and promote relaxation.
    Mechanism: Focused imagery shifts attention away from discomfort, reducing sympathetic arousal.

25. Progressive Muscle Relaxation
    Systematically tensing and releasing muscle groups from toes to head.
    Purpose: Release unconscious muscle tension contributing to nerve irritation.
    Mechanism: Alternating contraction and relaxation resets muscle spindle sensitivity.

Educational Self-Management

26. Ergonomic Education
    Training on proper workstation setup and posture.
    Purpose: Prevent aggravating nerve compression during daily activities.
    Mechanism: Aligning spine reduces sustained pressures on foramina during sitting or standing.

27. Activity Modification
    Learning to pace tasks and avoid repetitive upper-body twisting.
    Purpose: Minimize stress on the thoracic nerves.
    Mechanism: Gradual task progression prevents sudden overload of spinal structures.

28. Pain Education
    Understanding the pain-spasm cycle and strategies to interrupt it.
    Purpose: Empower patients to self-manage symptoms.
    Mechanism: Knowledge increases motivation to use adaptive behaviors and therapies.

29. Self-Monitoring Diaries
    Logging activities, pain levels, and triggers.
    Purpose: Identify patterns and effective strategies.
    Mechanism: Data tracking helps tailor therapy and avoid known aggravators.

30. Goal Setting and Action Planning
    Defining realistic functional goals (e.g., return to work tasks).
    Purpose: Guide rehabilitation and maintain motivation.
    Mechanism: Structured plans enhance adherence to therapies and lifestyle changes.

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Pharmacological Treatments

Below are 20 of the most commonly used medications for thoracic nerve root compression. Each entry lists drug class, typical adult dosage, recommended timing, and key side effects.

1. Paracetamol (Acetaminophen)

   • Class: Analgesic

   • Dosage: 500–1,000 mg every 6 hours (max 4 g/day)

   • Timing: With or without food, spaced evenly

   • Side Effects: Rare liver toxicity at high doses

2. Ibuprofen

   • Class: NSAID

   • Dosage: 200–400 mg every 4–6 hours (max 1,200 mg/day OTC)

   • Timing: With meals to reduce stomach upset

   • Side Effects: GI irritation, renal impairment

3. Naproxen

   • Class: NSAID

   • Dosage: 250–500 mg twice daily (max 1,000 mg/day)

   • Timing: Morning and evening with food

   • Side Effects: GI bleeding risk, fluid retention

4. Diclofenac

   • Class: NSAID

   • Dosage: 50 mg three times daily (max 150 mg/day)

   • Timing: With meals

   • Side Effects: Increased liver enzymes, cardiovascular risk

5. Celecoxib

   • Class: COX-2 selective NSAID

   • Dosage: 100–200 mg once or twice daily

   • Timing: With food to enhance absorption

   • Side Effects: Lower GI risk but possible cardiovascular events

6. Meloxicam

   • Class: Preferential COX-2 NSAID

   • Dosage: 7.5–15 mg once daily

   • Timing: With food

   • Side Effects: Edema, GI discomfort

7. Ketorolac

   • Class: Potent NSAID (short-term use)

   • Dosage: 10–20 mg every 4–6 hours (max 40 mg/day; ≤5 days)

   • Timing: After surgery or for acute pain, with food

   • Side Effects: High GI and renal toxicity risk

8. Indomethacin

   • Class: NSAID

   • Dosage: 25 mg two to three times daily

   • Timing: With meals

   • Side Effects: Headache, GI bleeding

9. Ketoprofen

   • Class: NSAID

   • Dosage: 50 mg two to three times daily

   • Timing: With food

   • Side Effects: Photosensitivity, GI irritation

10. Pregabalin

    • Class: Anticonvulsant (neuropathic analgesic)

    • Dosage: 75–150 mg twice daily (max 600 mg/day)

    • Timing: Morning and evening

    • Side Effects: Dizziness, weight gain, somnolence

11. Gabapentin

    • Class: Anticonvulsant

    • Dosage: 300–900 mg three times daily (max 3,600 mg/day)

    • Timing: With food, evenly spaced

    • Side Effects: Fatigue, peripheral edema

12. Amitriptyline

    • Class: Tricyclic antidepressant (neuropathic pain)

    • Dosage: 10–25 mg once daily at bedtime

    • Timing: Bedtime to reduce daytime drowsiness

    • Side Effects: Dry mouth, sedation, weight gain

13. Duloxetine

    • Class: SNRI antidepressant

    • Dosage: 30–60 mg once daily

    • Timing: With morning meal to avoid insomnia

    • Side Effects: Nausea, headache, increased sweating

14. Cyclobenzaprine

    • Class: Muscle relaxant

    • Dosage: 5–10 mg three times daily

    • Timing: With meals

    • Side Effects: Drowsiness, dry mouth

15. Baclofen

    • Class: Muscle relaxant

    • Dosage: 5 mg three times daily (max 80 mg/day)

    • Timing: With meals

    • Side Effects: Weakness, dizziness

16. Prednisolone

    • Class: Oral corticosteroid

    • Dosage: 10–60 mg daily for 5–10 days

    • Timing: Morning to mimic natural cortisol rhythm

    • Side Effects: Hyperglycemia, insomnia, mood changes

17. Dexamethasone

    • Class: Corticosteroid (injection or oral)

    • Dosage: 4–10 mg injection for epidural use; 0.5–1 mg oral daily

    • Timing: Epidural administered under guidance; oral in morning

    • Side Effects: Immunosuppression, fluid retention

18. Tramadol

    • Class: Weak opioid

    • Dosage: 50–100 mg every 4–6 hours (max 400 mg/day)

    • Timing: With food to reduce nausea

    • Side Effects: Constipation, dizziness, risk of dependence

19. Codeine

    • Class: Opioid

    • Dosage: 15–60 mg every 4 hours as needed (max 360 mg/day)

    • Timing: With meals

    • Side Effects: Constipation, sedation, respiratory depression

20. Metamizole (Dipyrone)

    • Class: Non-opioid analgesic/anipyretic

    • Dosage: 500–1,000 mg every 6–8 hours (max 4 g/day)

    • Timing: With water

    • Side Effects: Rare agranulocytosis, hypotension

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Dietary Molecular Supplements

Below are 10 supplements studied for nerve health and pain modulation, with their typical dosages, primary functions, and proposed mechanisms.

1. Methylcobalamin (Vitamin B12)

   • Dosage: 1,000 µg daily

   • Function: Supports myelin sheath repair

   • Mechanism: Cofactor for methylation reactions in nerve fiber regeneration

2. Alpha-Lipoic Acid

   • Dosage: 600 mg daily

   • Function: Antioxidant that reduces nerve inflammation

   • Mechanism: Scavenges free radicals and restores other antioxidants

3. Omega-3 Fatty Acids

   • Dosage: 1,000 mg EPA/DHA combined daily

   • Function: Anti-inflammatory support for nerve tissues

   • Mechanism: Incorporates into cell membranes, modulating inflammatory cytokines

4. Vitamin D3

   • Dosage: 1,000–2,000 IU daily

   • Function: Maintains nerve function and modulates pain pathways

   • Mechanism: Binds to receptors on neurons and immune cells, reducing pro-inflammatory mediators

5. Vitamin B6 (Pyridoxine)

   • Dosage: 50 mg daily

   • Function: Essential for neurotransmitter synthesis

   • Mechanism: Cofactor for glutamate decarboxylase, regulating excitatory/inhibitory balance

6. Vitamin B1 (Thiamine)

   • Dosage: 100 mg daily

   • Function: Promotes nerve energy metabolism

   • Mechanism: Activates enzymes in carbohydrate metabolism to fuel nerve cells

7. Magnesium

   • Dosage: 300–400 mg daily (elemental)

   • Function: Reduces nerve excitability and muscle spasms

   • Mechanism: Blocks NMDA receptors and calcium channels in neurons

8. Curcumin

   • Dosage: 500 mg twice daily (with black pepper extract)

   • Function: Anti-inflammatory and analgesic

   • Mechanism: Inhibits NF-κB pathway, reducing cytokine production

9. Vitamin E

   • Dosage: 200 IU daily

   • Function: Protects nerve cell membranes from oxidative damage

   • Mechanism: Lipid-soluble antioxidant in neuronal membranes

10. Coenzyme Q10

    • Dosage: 100 mg daily

    • Function: Supports mitochondrial energy production

    • Mechanism: Electron carrier in the respiratory chain, enhancing ATP synthesis

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Regenerative and Advanced Injectable Therapies

This section covers 10 advanced biologic and device-related therapies—including bisphosphonates, viscosupplementation, regenerative injections, and stem cell treatments. Each entry lists dosage, primary function, and proposed mechanism.

1. Alendronate (Bisphosphonate)

   • Dosage: 70 mg once weekly

   • Function: Prevent vertebral bone loss that can secondarily narrow foramina

   • Mechanism: Inhibits osteoclasts, preserving bone height and foraminal space

2. Zoledronic Acid

   • Dosage: 5 mg IV annually

   • Function: Strengthens vertebral bone and reduces microfractures

   • Mechanism: Potent osteoclast inhibition to maintain foraminal integrity

3. Hyaluronic Acid Injection

   • Dosage: 20 mg per facet joint (1–2 mL)

   • Function: Lubricates facet joints to reduce mechanical pressure

   • Mechanism: Viscosupplement restores synovial fluid viscosity, smoothing joint motion

4. Hylan G-F 20

   • Dosage: 2 mL per joint, up to 3 injections

   • Function: Similar to hyaluronic acid, for facet joint lubrication

   • Mechanism: High-molecular-weight gel cushions joint surfaces

5. Platelet-Rich Plasma (PRP)

   • Dosage: 3–5 mL injected around the affected nerve root

   • Function: Stimulates local tissue healing and reduces inflammation

   • Mechanism: Growth factors in platelets activate repair pathways

6. Autologous Conditioned Serum

   • Dosage: 2 mL per injection, 2–3 sessions

   • Function: Provides anti-inflammatory cytokines (e.g., IL-1Ra)

   • Mechanism: Processed autologous blood enriched in anti-catabolic mediators

7. Allogeneic Mesenchymal Stem Cells (MSCs)

   • Dosage: 1–5 × 10⁶ cells per injection

   • Function: Promote disc regeneration and nerve repair

   • Mechanism: Paracrine signaling releases neurotrophic factors

8. Autologous Adipose-Derived MSCs

   • Dosage: 1–5 × 10⁶ cells from liposuction aspirate

   • Function: Same as allogeneic MSCs, lower immunogenicity

   • Mechanism: Differentiation into supportive stromal cells and secretion of growth factors

9. Neural Stem Cell Therapy

   • Dosage: Under investigation; typically 0.5–1 mL containing progenitors

   • Function: Replace damaged nerve cells and restore conduction

   • Mechanism: Differentiation into neurons and glia, remyelination support

10. iPSC-Derived Neural Progenitors

    • Dosage: Experimental, delivered via intrathecal or perineural injection

    • Function: Targeted repair of specific nerve root segments

    • Mechanism: Personalized cell therapy to regenerate damaged neural tissue

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Surgical Procedures

When conservative measures fail or neurological deficits progress, 10 surgical options may be considered. Each includes a brief description of the procedure and its primary benefits.

1. Posterior Laminectomy and Foraminotomy

   • Procedure: Remove the lamina (roof) of the vertebra and widen the foramen.

   • Benefits: Direct decompression of the nerve root with immediate relief.

2. Microdiscectomy

   • Procedure: Under microscope guidance, remove herniated disc fragments compressing the nerve.

   • Benefits: Minimally invasive, preserves surrounding tissues, quicker recovery.

3. Hemilaminectomy

   • Procedure: Remove half of the vertebral lamina on one side.

   • Benefits: Targeted decompression with less instability.

4. Endoscopic Foraminal Release

   • Procedure: Use an endoscope to visualize and clear foraminal stenosis.

   • Benefits: Small incisions, less muscle disruption, faster rehabilitation.

5. Laminoplasty

   • Procedure: Reconstruct and hinge open the lamina rather than removing it.

   • Benefits: Maintains spinal stability while expanding the canal.

6. Minimally Invasive Tubular Decompression

   • Procedure: Dilate a small soft-tissue corridor and remove compressive lesions.

   • Benefits: Reduces blood loss, muscle damage, and hospital stay.

7. Pedicle Screw Fixation and Fusion

   • Procedure: Place screws in adjacent vertebrae and connect with rods, then bone graft for fusion.

   • Benefits: Stabilizes segment after decompression, prevents recurrence.

8. Thoracoscopic Discectomy

   • Procedure: Video-assisted removal of the disc through a small chest incision.

   • Benefits: Direct anterior access, less muscle trauma on the back.

9. Anterolateral Thoracotomy

   • Procedure: Open chest approach to access thoracic disc and foramina.

   • Benefits: Excellent visualization for giant or central herniations.

10. Artificial Disc Replacement (Experimental in Thoracic Spine)

    • Procedure: Remove damaged disc and insert a prosthetic disc.

    • Benefits: Preserves motion at the segment, potentially avoids fusion.

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Prevention Strategies

1. Maintain a neutral spine during sitting and standing.

2. Use an ergonomic workstation with proper chair height.

3. Perform regular core-strengthening exercises.

4. Practice safe lifting—bend at hips and knees, avoid twisting.

5. Keep a healthy weight to reduce spinal load.

6. Quit smoking to improve disc nutrition and healing.

7. Take frequent breaks from prolonged sitting or driving.

8. Use a supportive mattress and pillow for proper alignment.

9. Stay hydrated to maintain disc elasticity.

10. Schedule annual back check-ups if you have risk factors.

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When to See a Doctor

Seek professional evaluation if you experience any of the following:

• Severe or worsening pain that limits daily activities.

• Numbness or tingling that spreads beyond the thoracic region.

• Muscle weakness in the torso or lower limbs.

• Loss of bowel or bladder control.

• Gait disturbances or difficulty walking.

• Persistent symptoms despite 4–6 weeks of conservative care.

• Night pain that awakens you.

• Fever or unexplained weight loss (possible infection or malignancy).

• Radiating chest pain mimicking heart conditions (urgent evaluation).

• Sudden onset of neurological deficits.

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What to Do & What to Avoid

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Frequently Asked Questions

1. What exactly is thoracic transverse nerve root lateral compression?
   It’s a condition where a nerve root in the mid-back region is pinched as it exits the spine, causing pain and numbness along that nerve’s path.

2. What causes this nerve compression?
   Common causes include herniated thoracic discs, bone spurs, facet joint enlargement, and ligament thickening narrowing the foramen.

3. How is it diagnosed?
   Diagnosis combines medical history, a physical exam (checking reflexes, strength, sensation), and imaging tests like MRI or CT scans.

4. Can it heal on its own?
   Mild cases may improve with rest, physiotherapy, and lifestyle changes, but moderate–severe cases often require medical intervention.

5. Is surgery always necessary?
   No. Over 70–80% of patients improve with conservative (non-surgical) treatments within 6–12 weeks.

6. How long is the typical recovery?
   With proper care, many patients see meaningful relief within 4–8 weeks; full functional recovery may take several months.

7. Can I continue working?
   Many people can work with adjustments (ergonomic setup, light duties). Heavy manual labor may require a medical leave.

8. Are there long-term complications?
   If untreated, chronic compression can lead to permanent nerve damage, weakness, or sensory loss.

9. What lifestyle changes help?
   Ergonomic improvements, core strengthening, weight management, and smoking cessation all reduce risk and support recovery.

10. Do injections help?
    Epidural steroid injections or PRP can provide temporary relief and reduce inflammation around the nerve.

11. What are the risks of surgery?
    Potential risks include infection, bleeding, nerve injury, and the need for future operations if the underlying cause recurs.

12. Can I prevent recurrence?
    Yes. Ongoing exercise, posture control, and avoiding high-risk activities help prevent future episodes.

13. Are supplements effective?
    Certain vitamins (B12, D), omega-3 fatty acids, and antioxidants can support nerve health but are adjuncts—not stand-alone treatments.

14. When should I seek emergency care?
    Loss of bowel or bladder control, sudden severe weakness, or symptoms suggesting spinal cord involvement require immediate attention.

15. Where can I learn more?
    Reputable sources include NIH/National Library of Medicine (PubMed), Johns Hopkins Medicine, and professional spine societies.

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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