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Category Archives: Sciatica

A visualization of sciatic pain as a man holds his lower back while standing from his desk.

Sciatic Pain & Your Spine: How Acupuncture Can Help

An inflamed, compressed, or irritated sciatic nerve root causes sciatica, also known as sciatic pain. There is pain radiating down the legs and into the buttocks caused by the sciatic nerve. Spinal stenosis, a herniated disc, or bone spurs are the most common causes of this condition.

 

Several Types of Sciatic Pain

Symptoms of sciatic pain differ depending on whether one or both legs are affected and how long they last. There are four types of sciatica: Acute, chronic, alternating, and bilateral.

Both sides of the sciatic nerve originate from the lower spine and travel through the pelvis and buttocks. Afterwards, the nerve passes along the back of each upper leg before splitting into branches that reach the knee and at the feet. While the pain starts in nerve roots located on either side of the lower spine, it then spreads through the nerve that runs along each leg from the buttock to the foot.

An uncomfortable and common condition, sciatica is also known as sciatic nerve pain. Approximately 40 percent of the general population is affected at any given time. A type of pain that can profoundly affect daily life, sciatica can be very annoying. This is why acupuncture and back pain are so frequently researched these days, due to a strong healing correlation.

 

The Sciatic Nerve

A nerve originates from the L4 vertebra, the L5 vertebra (top of spine), and the sacrum, which is the triangle-shaped bone just below the vertebrae. Afterward, the sciatic nerve splits and runs through each thigh. There can be shooting pains down the sciatic nerve when any of these nerves are irritated.

  • Acute sciatica. In sciatica, an acute onset is defined as a recent onset with a pain duration of four to eight weeks or less. Oftentimes, it responds to at-home treatment and does not require medical attention.
  • Chronic sciatica. The pain associated with chronic sciatica lasts more than eight weeks and is persistent. It is possible that at-home treatments will not provide relief. Choosing the best treatment should be determined by a healthcare professional.
  • Bilateral sciatica. Both legs are affected by bilateral sciatica at the same time. A disc or vertebral degeneration may cause this extremely rare condition.
  • Alternating sciatica. Sciatica that alternates between both legs is known as “alternate sciatica.” Despite being rare, sacroiliac joint degeneration may cause this type of sciatica.

However, before focusing too much on sciatic pain in your legs, know that the underlying issue stems from your spine. This is one reason acupuncture for chronic back pain has become such a popular treatment for so many patients today.

 

The Source of Your Sciatic Nerve Problems

In light of the fact that the sciatic nerve originates in the L4 and L5 vertebrae, along with the sacrum, this can lead to a variety of symptoms and types of sciatic pain. When sciatica originates in the L4 nerve root, the pain usually travels down the outer part of the thigh, around the knee, and down the inner aspect of the leg. As well as on the inside of the leg, it can also occur on the outside.

L5 pain is likely to radiate down the side of the leg and the back of the thigh if it is coming from the nerve root. Big toe pain can extend all the way to the top of the foot.

According to many doctors who study acupuncture and back pain, the sacral nerve may be the source of your sciatic nerve pain. An individual usually feels pain along the back of their leg and on the outside of their foot.

There are several things that can cause sciatica, such as a herniated disc, bone spurs, collapsed vertebrae, infection, tumor, mass in the pelvis, or cysts which pinch the lumbar nerves. Acupuncture treatment for back pain is usually one of the best treatments available.

 

Insights on Herniated Discs and Sciatic Pain

Sciatica and sciatic pain are most commonly caused by a herniated disc. Disc tears or cracks can pinch the sciatic nerve when they bulge into the spinal canal. Some people suffer from pain for a much longer period of time before resolving their symptoms.

In the spine, discs act as cushions between bones. Pain, weakness, or numbness can be caused when a disc is pushed out of place and tears into the outer layer of the spine.

Herniated discs can cause no symptoms, but sometimes their pain is so severe that surgery is needed. As part of this pain management protocol, doctors identify a patient’s specific needs (such as the source of their pain) through an assessment, and they then create a personalized set of exercises that target posture, sleep modifications, and other advice to improve alignment and pain. Acupuncture and back pain specialists have been studying these issues — along with appropriate treatment and protocol — for decades.

Even healthy people can develop disc protrusions. Nearly one-third of healthy 20-year-olds have disk protrusions, according to a famous study. A herniated disk affects almost every second person without low back pain as they age, and up to 43 percent at the age of 80. There are even more disk bulges at the age of 80, with 84 percent.

You should realize that even if your MRI scan does show a bulging or protruding disc, these findings are completely normal. An MRI scan alone cannot explain pain because it is a complex phenomenon. Acupuncture for chronic back pain can usually solve many of these sophisticated spine problems, depending on the patient.

 

Sciatica and Neurological Symptoms

Sciatic pain may be accompanied by neurological symptoms when the sciatic nerve is compressed. Symptoms that may come with this condition include:

  • Your thigh muscles are weak. The thighs may appear weak when brought together and the thigh muscles are affected.
  • You experience muscle weakness in your legs and feet. There may be weakness when bending the knee or pointing the foot upwards and/or downwards if the leg muscles are affected. Walking may be difficult due to these issues, resulting in foot drop. Walking on tiptoes or rising from a sitting position may also be difficult.
  • You feel numbness. The sciatic nerve may not allow nerve impulses to pass through, resulting in loss of sensation. In most cases, numbness affects the side of the calf, the heel, the sole, or the top of the foot.
  • You experience paresthesia. Due to improper nerve conduction, an abnormal sensation is felt on the skin. You may experience tingling, tightness, pins-and-needles, or crawling sensations in your thigh or leg back.

It’s more common when the sciatic nerve is compressed that neurological symptoms result in reduced function of the affected leg, a situation that acupuncture and back pain doctors can directly address.

 

Sciatic Pain Treatment for Suffering

Surgery for sciatic pain should be the last resort unless it’s urgent or an emergency. The problem may require a variety of surgical options, but biportal endoscopic spine surgery is usually the best option for relieving pressure on the nerves.

Sciatica surgery has often been found to provide relatively little pain relief compared to non-surgical options after just a few months. After a full year, most patients do not experience significant pain relief.

Considering the pain associated with sciatic nerve pain, finding effective relief is crucial. It is often worse to suffer from leg pain, also known as radiculopathy, than from back pain. The sensation is usually felt in one leg and can be unbearable. It is often compared to a toothache type of nerve pain.

Sciatic nerve pain can be relieved with several home remedies, exercises, and conservative approaches. The best thing you can do for your pain is to try all non-surgical modalities, unless your injury necessitates an emergency visit.

Sciatic nerve pain can be treated with anti-inflammatory medications, nutrition changes (as recommended by your doctor or nutritionist), and stretches and exercises performed with a physical therapist, including core and trunk stability exercises.

Acupuncture treatment for back pain can also be integrative — and if the pain happens to be very severe or debilitating, epidural injections may be an option.

 

Acupuncture Therapy Cures a Variety of Ailments

Often, acupuncture and back pain therapy can help with a lot of health problems, including sciatic pain. It’s usually used for chronic (long-term) pain like arthritis, back pain, neck pain, shoulder pain, knee pain, headaches, migraines, sports injuries, jaw pain, sinus congestion and facial pain, neuropathy, and menstrual cramps.

Your body may need a number of treatments, depending on how severe your condition is. Most patients have an appointment once a week. Some people get treatment more often, while others get it less frequently. Our acupuncturists can recommend the right schedule for each patient.

The exact healing mechanism behind acupuncture therapy isn’t fully understood, but it’s thought to involve a combination of things. One of those things is the release of endorphins, which relieve pain. Stimulating the nervous system is another, which can also help regulate mood, pain, and other bodily functions. It also helps you relax and relieve stress.

Although acupuncture for chronic back pain treatment is generally safe, make sure you find a licensed acupuncturist in your state. It’s not uncommon for patients to endure side effects, especially since needles can cause mild pain or soreness. Certain patients can also experience bruising, dizziness, lightheadedness, and nausea.

A professional acupuncturist can help, as tailored and customized treatment plans are known to provide the best solutions. There are a variety of health problems acupuncture therapy can treat, and it’s usually very safe and effective.

 

Wellness and Pain Can Help

A range of options for sciatic pain are available at Wellness and Pain. We offer conservative treatments, routine visits, and minimally invasive quick-recovery procedures. We can keep you free of problems by providing lifestyle education and home care advice to help you avoid and manage issues, quickly relieving the inhibiting lifestyle conditions when complications arise.

At Wellness and Pain, we personalize patient care plans based on each patient’s condition and unique circumstances to relieve pain, improve mobility and mental space, and improve your overall health.

A visualization of buttock lower back pain radiating up a runner's buttock and lower back.

Underlying Causes of Buttock Lower Back Pain

Buttock lower back pain is one of the most common types of pain, and it can easily radiate through nerves. There are millions of Americans who suffer from lower back pain every year, according to medical professionals — and much of this pain goes into the buttocks.

There is a close connection between the lower back and the buttocks that most of us overlook. Most of us don’t realize how bad our back and buttocks are until we begin experiencing pain in those areas. Sciatica pain and back pain are closely related medical conditions, and back pain is often the cause of sciatica pain. Your mind-numbing ache in buttocks and back of thighs is real.

Inflammation of the buttock area, numbness in the leg, pain in the upper leg, pain throughout the back of the leg, pain in the lower back, and pain in the buttocks are all symptoms of lower back pain and buttock pain.

 

Causes of Buttock Lower Back Pain

Bursitis, cysts, abscesses, sacroiliac joint dysfunction, arthritis, and vascular disease can all cause buttock lower back pain. However, for many victims, the problem turns out to be a herniated disk, degenerative disk disease, piriformis syndrome, or sciatica.

Sciatica isn’t a disease or condition — it’s a symptom. The pain radiates down your sciatic nerve, which runs from your lower back through your buttocks and down each leg. A herniated disk or narrowed spine parts can cause sciatica, as well as an ache in buttocks and back of thighs.

Almost everyone has experienced pain in buttocks and legs at one point or another, but if it’s caused by sciatica, something’s amiss. Symptoms of sciatica include back pain that starts in the buttocks and runs down one leg. There are many types of sciatica pain, ranging from dull and achy to shooting and stabbing. In addition, you might experience numbness or tingling, which is often worse after sitting or standing for a long time, or when you cough.

A single episode might last for a few hours, or it can come and go for months at a time. Pain management specialists use your symptoms, severity, and duration to determine the root cause of your pain.

 

Your Sciatic Nerve and Buttock Lower Back Pain

No other nerve in your body is longer or larger than the sciatic nerve, which is usually the root cause of buttock lower back pain. Sciatica leg pain is one of the most common pain management issues for young, middle-age, and older people due to this muscle running down the backside of both legs.

Sciatic nerves originate in the lower back. They travel through the buttocks and down the back of the legs. Thighs, calves, feet, and toes are all served by portions of this nerve. In addition to affecting the sole of your foot and the outer and back portions of your lower leg, sciatica also impacts the back of your thigh. Your ache in buttocks and back of thighs is usually all connected. Muscles in your legs and knees are often affected as well.

As a result of its function, the sciatic nerve serves two main purposes. With its complex motor function, you can move your legs and feet, and with its sensory function, you can feel sensations within your legs. The sciatic nerve is an amazing tool in your lower extremities. You can bend your knee, extend your knee, rotate your thigh, point your foot, and flex your toes — all using the sciatic nerve.

 

Consult the Experts on Buttock Lower Back Pain

When you reach your 40s and 50s, you’re more likely to suffer from sciatica and buttock lower back pain since the conditions that cause it become more prevalent. Sciatica is estimated to affect 40 percent of all adults, although studies differ on how many times patients suffer from it throughout their lives.

In the United States, a notable number of people suffer from sciatica every year, making it one of the most common musculoskeletal disorders. Sciatica causes a high disability burden for individuals and a high health-related cost for society.

Workplace activity and occupational workload, such as lifting or carrying heavy objects, have been found to increase the risk of sciatica. Herniated lumbar discs are also associated with non-occupational lifting, especially with straight knees and a bent back. Risk factors for sciatica include work-related twisting of the trunk and exposure to whole-body vibrations. These include driving a car or operating a machine. Overweight and obese individuals, along with those who lift heavy objects and are exposed to whole-body vibration, appear to have the highest risk of hospitalization for sciatica. These groups also experiences a severe ache in the buttocks and back of the thighs.

The problem of sciatica remains very real for many workers who don’t work in physically demanding occupations. It’s possible for office workers or work-from-home professionals — even those who are physically fit — to suffer from bouts of sciatica and aching pain in buttocks and legs simply due to their sedentary jobs.

The best diagnosis is obtained through a physical examination, as well as a review of your medical history. Once sciatica is confirmed and the problematic area pinpointed, a customized treatment plan can be developed just for you.

 

What Causes Sciatica and Buttock Lower Back Pain?

Sciatica and buttock lower back pain can be caused by degenerative spinal arthritis, slipped discs, lumbar disc disease, and lumbar spine injury or trauma. A breakdown of these causes are as follows:

  • Spinal stenosis in the lumbar region.This comes as a result of narrowing within the spinal canal in the low back. This ache in buttocks and back of thighs is caused by radicular discomfort.
  • A healthy (or otherwise injured) disk that has herniated.A herniated disc of the lumbar spine, which compresses a nerve root, is one of the most common causes of sciatica.
  • Disk degeneration.Degenerative disk disease is the breakdown of cushions between the vertebrae.
  • Symptoms from spondylolisthesis.This happens when there is compression of a nerve root by one vertebrae sliding over another.
  • Other reasons for cause.A tumor, polyradicular neuropathy, or diabetic neuritis can also cause sciatica.

 

Additional Sciatica and Other Helpful Facts

In general, men and middle-aged adults are most likely to suffer from sciatica and buttock lower back pain. There is a threefold increase in sciatica among men compared to women. Although sciatic nerve pain can affect people as young as 20, it’s most common among middle-aged adults.

It’s also important for you to know that diabetes can cause pain similar to sciatica. Sciatica may be responsible for shooting leg pain if you have diabetes. The pain caused by diabetic nerves can be similar to pain caused by sciatic nerves, but they are not the same. An individual with sciatica may experience burning, numbness, and shooting pains in one or both legs as a result of peripheral neuropathy. However, leg pain caused by diabetes shouldn’t necessarily be attributed to sciatica. Find out what’s causing your pain. This way, your pain management specialist or doctor can prescribe a treatment plan that best suits you.

The way you walk can also be affected by sciatica, causing pain in buttocks and legs. For some patients, Antalgic Gait occurs when they adjust their walking to cope with sciatic leg pain. As a result of sciatica pain, antalgic gait develops when you adjust your stride length on the affected leg, resulting in a limp. Developing various walking patterns can aid in reducing sciatica pain. However, there are also alternative methods to effectively manage your pain, offering long-term relief. Consult a doctor or pain management specialist about addressing the underlying problem. It’s usually your low back and leg pain caused by sciatica.

 

Weather can Affect it too

It is also possible for sciatica to flare up during the colder months. In turn, this can cause an ache in your buttocks and back of thighs. Pain severity is strongly correlated with the weather. For people with chronic pain and particularly sciatica, the winter months are much more difficult. Due to decreased blood flow, muscles become tighter and tenser in the colder months. Conversely, in the warmer months, muscles tend to relax and become looser. If you live in an area that gets hit hard by snow and have to shovel a lot, you’re more likely to suffer from muscle strains and sprains as the cold weather stiffens your muscles. If you have sciatic pain (also known as radiculopathy) from snow shoveling, the pain may be exacerbated by an underlying condition, such as a herniated disc.

In most cases, sciatica does not require surgery. However, if severe symptoms aren’t treated, sciatica can cause major problems in the long run, such as terrible aching pain in buttocks and legs. Be on the lookout for neurological symptoms such as weakness, numbness, and tingling. Moreover, the most serious condition is loss of bowel and bladder control, which requires immediate medical attention. There may be a need for surgery if these symptoms are indicative of serious nerve compression. Call your doctor immediately if you experience these symptoms, as ignoring them could result in permanent nerve damage.

 

Wellness and Pain Can Help

A range of treatment options for buttock lower back pain are available at Wellness and Pain. We offer conservative treatments, routine visits, and minimally invasive quick-recovery procedures. We can assist you in maintaining a problem-free lifestyle by offering lifestyle education and home care advice. This will help you find quick relief from the discomfort in your buttocks and back of thighs.

At Wellness and Pain, we personalize patient care plans based on each patient’s condition and unique circumstances to relieve pain, improve mobility and mental space, and improve your overall health.

SEO - Sciatica Pain Relief is Within Reach: Here’s How

Sciatica Pain Relief

Sciatica Pain Relief is Within Reach: Here’s How

An injury or irritation to the sciatic nerve causes sciatica, which starts in the butt and gluteal muscles and deserves expert sciatica pain relief treatment. There’s no true sciatic nerve injury that causes sciatica, but it’s commonly used to describe any lower back or leg pain that starts in the lower back. This lower back pain is caused by a nerve injury, causing irritation, inflammation, pinching, or compression.

The sciatic nerve is the longest in the body. Five nerves come from the lower back called the lumbar spine, and three from the sacrum. Five separate nerve roots actually form two sciatic nerves. Two sciatic nerves run down one leg, from your hips to your buttocks, ending just below the knee on each side. Other nerves branch off the sciatic nerve, which then runs down your leg and into your feet.

Sciatica Pain Relief: First, How Bad is Your Discomfort?

Basically, sciatica is pain anywhere along the sciatic nerve path — from the lower back, through the hips, buttocks, and down into the legs, which are all areas you should be seeking sciatica pain relief through proper treatment. In addition to muscle weakness and numbness in your leg, you could feel tingling pins-and-needles in your foot and toes too.

While irritation, inflammation, pinching or compression of a nerve can cause sciatica pain, most people get it because of a herniated or slipped disk. Self-care and time usually cure sciatica, but that’s not always the case for many patients.

The misery and agony from sciatica is described differently depending on the cause, which means relief from the pain will be discovered differently as well. The pain can be sharp, shooting, or jolting for some people. Burning, jabbing, or stabbing are other ways to describe this pain. Oftentimes, there’s no telling if the pain is constant or if it comes and goes. Leg pain tends to be worse than lower back pain. Whenever you stand up or sit for long periods of time or twist your upper body, the pain may get worse. Sudden movements, like coughing or sneezing, often worsen pain.

Lifestyle Changes, Cures, and Sciatica Pain Relief

Some causes of sciatica aren’t preventable, such as degenerative disk disease, sciatica during pregnancy, and accidental falls — but sciatica pain relief is still worth the effort. Take these steps to protect your back and reduce your risk of sciatica, even though it’s not possible to prevent all cases:

  • Lose weight: Extra weight and poor diet cause inflammation and pain. Check out various healthy diets or lifestyle-change diets if you want to lose weight. As you get closer to your ideal weight, your spine will be less strained.
  • Take good care of your posture: While sitting, standing, lifting objects, and sleeping, follow good posture techniques. Having pain can be a sign you’re not aligned correctly. Make sure you’re sitting right if you’re sore or stiff.
  • You should choose low-impact exercises like swimming, walking, yoga, or Tai Chi to avoid hurting your back.
  • Keeping stairs and walkways clear of clutter can keep you from falling. Wear shoes that fit and wear shoes that fit well. Don’t forget to put grab bars in bathrooms and stair rails on stairways.
  • Get regular exercise: Stretching keeps your joints flexible, and strengthening your core gives you a strong lower back and abdomen. Your back is supported by these muscles.  Also, don’t sit for too long.
  • Stop smoking: Nicotine reduces blood flow to bones. Spine and disk problems result when the spine and disks weaken, putting more stress on them.

Relief from the pain starts with lifestyle changes, which ultimately lead to some sort of cure.

Connection Between Risk, Complication, and Sciatica Pain Relief

While sciatica pain relief is within grasp for patients who are suffering, it all comes down to tailoring changes within your daily choices, habits, and environment. Sciatica is more likely if you:

  • Sustain an injury. You’re more likely to get sciatica if you damage your lower back or spine.
  • Have a physical job. Heavy lifting or long sitting times often lead to low back problems.
  • Have too much weight. As you gain weight, your back muscles have to work harder. It can cause back strains, back pains, and other problems.
  • Exercise without proper posture. When you lift weights or do other strength exercises, even if you’re fit and active, you can still get sciatica if you don’t follow proper body form. This is actually one of the biggest reasons, which means your sciatica pain relief efforts should make proper posture with exercise a priority.
An illustration of the correct lifting form to help sciatica pain relief.
  • Don’t have a strong core. Back and abdominal muscles make up your core. You’ll have more support for your lower back if you have a strong core.
  • Are a diabetic. Nerve damage increases your chances of sciatica with diabetes.
  • Tobacco smoke damages spinal tissue, weakens bones, and wears down vertebral disks faster; therefore, nicotine can cause serious problems.
  • Natural aging wears down your spine’s bone tissue and disks. The changes in bone, disks, and ligaments that naturally occur with aging can put your nerves at risk.
  • Are a victim of osteoarthritis. The condition can damage your spine and hurt your nerves.
  • Live a sedentary lifestyle. When you’re sitting all the time without exercising and keeping your muscles flexible, you’re more likely to get sciatica.

Pain alleviation isn’t so difficult when you commit to following some simple ground rules.

Why Do You Get Sciatica? It’s Complicated…

There are a lot of reasons why you can get sciatica, which means there are even more reasons why sciatica pain relief comes by utilizing a variety of tools, resources, and good habits. Reasons for experiencing sciatica include:

  • One vertebra slips out of position and narrows the opening through which the nerve exits, called spondylolisthesis. The risk of sciatic nerve pinching rises when the spine extends.
  • A condition known as “osteoarthritis” is caused by bone spurs, which are jagged edges of bone found in aging spines.
  • A herniated or slipped disk that pressures a nerve root. This usually causes sciatica. The disks between the vertebrae cushion each other. Herniation occurs when the gel-like center of a disk bulges out of a weakness in its outer wall from pressure from vertebrae. This squeezes your sciatic nerve.
  • Stenosis is the narrowing of the spinal canal. There is less space for the spinal cord and nerves due to this narrowing.
  • An encroaching tumor in the lumbar spinal canal.
  • Natural wear and tear degenerates disks between vertebrae. Disk wear shortens the height of the nerve passageways and creates spinal stenosis. In turn, this pinches the sciatic nerve roots.
  • There is a condition known as “piriformis syndrome” that occurs when the piriformis muscle, located deep in the buttocks, tighten or spasm. Sciatic nerves become pressured and irritated.
  • There’s a rare but serious condition called “cauda equina syndrome,” which affects the bundle of nerves at the end of the spinal cord. A common symptom is pain down the leg, numbness around the anus, and bowel and bladder problems.

A long-term reprieve from your pain — if not perpetual — is the goal of any sciatica pain relief treatment plan.

Can You Self-Care at Home Before Seeing a Doctor?

Since different pains have different types, intensities, and causes, there’s no one-size-fits-all approach when it comes to sciatica pain relief. Depending on the patient, a more aggressive approach may be tried first. The general rule is: If self-care treatments, like ice, heat, stretching, over-the-counter medicines, haven’t worked for you after six weeks, then it’s time to see a doctor.

You can also try the following for relief from the pain:

  • Treatment for physical problems. In physical therapy, you’re trying to find exercises that reduce sciatica symptoms by reducing pressure on nerves. You should do stretching exercises and aerobic exercises (like walking, swimming, water aerobics). Physical therapists can help you customize your routine to strengthen your back, abdomen, and legs.
  • Therapeutic alternatives. The use of alternative therapies is rising, and they treat and manage all kinds of pain. Yoga or acupuncture are some other ways to get rid of sciatic pain. Massages often help muscle spasms that accompany sciatica. The use of biofeedback can help manage pain and relieve stress.
  • Drugs or prescriptions. For muscle spasms, your doctor may prescribe muscle relaxants. If the pain is bad, you can also try tricyclic antidepressants and anti-seizure drugs. Pain medicines might be a part of your treatment plan early on, depending on how bad you feel.
  • Injections in the spine. A corticosteroid injection can help reduce swelling and pain around the affected nerve roots. Given under local anesthesia, injections usually last three months. Get your healthcare provider’s advice on how many injections you can receive and whether there are any risks.

Ultimately, with so many sciatica pain relief options available, one will be better suited to your personal circumstance than others.

Wellness and Pain

After an easy 10-minute ultrasound, we can diagnose and treat you using proper sciatica pain relief techniques. After which, you can live a healthier, more active life. Aside from ultrasound, electromyography (EMG), and nerve conduction studies, Wellness and Pain has state-of-the-art testing equipment. Plus, we offer muscle injections to help with recovery and pain.

You’re in good hands with Wellness and Pain. Take advantage of your ultrasound today (covered by insurance and most unions).

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Wellness and Pain accepts most major insurance plans. Here is a list of some of the major insurance plans we accept. If you do not see your insurance plan listed, please call our office to confirm.

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