SlideShare a Scribd company logo
1 of 46
Disclaimer ,[object Object],[object Object],[object Object]
Interventional Pain Management;  Way forward to  manage chronic pain Dr Ashok Jadon,  MD DNB   Aesculap Academy   IPM Fellowship   Sr Consultant Anaesthesia
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],What it is ?
Non-opioids Weak opioids +/- non-opioids Strong opioids Recovery   Operation Treatment of Low Back Pain World of Misery   Non-pharmacological methods
Non-opioids Weak opioids +/- non-opioids Strong opioids Recovery   Operation Treatment of Pain IPM Non-pharmacological methods It fills the gap between pharmacologic management of  pain & more invasive operative procedure.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],IPM IPM are group of procedures with different mechanism of actions
Scope/ indications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Structures responsible for LBP
Major Causes of Low Back Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www. pain india.net
Low Back Pain:  Red Flags ,[object Object],[object Object],[object Object],[object Object],[object Object]
Facet Joint Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Facet Joint Interventions Lumbar โ€œ Scottie Dogโ€ View
C-arm should be rotated such a way so that facet joint is opened up maximally & end plate of two adjacent vertebrae are in line. Disc space between L4-L5 disc Facet joint Inferior end plate of L4 Vertebra  Superior end plate of L5 Vertebra
Facet Joint Interventions Lumbar - RF L5 L4 S1
Radiofrequency Ablation (RF)
LBP ; Disc (Disc Cause LBP 25% to 45%)
Disc procedures ,[object Object],[object Object],[object Object],[object Object],[object Object],www. pain india.net
Epidural Approaches ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Midline Interlaminar L5-S1
Transforaminal Approach
ย 
Transforaminal Approach
Ozone Nucleolysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intradiscal Procedures ,[object Object],[object Object],[object Object],[object Object]
I-DET
Percutaneous Disc Decompression/Discectomy www. pain india.net   17G needle introduced, motorized probe is introduced It breaks the nucleus pulposus into fine particles and sucks it out.
Vertebroplasty
POST LAMINECTOMY SYNDROME ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
POST LAMINECTOMY SYNDROME ,[object Object],[object Object],[object Object]
Epidural Adhesinolysis Normal Filling defect in FBSS www. pain india.net
POST LAMINECTOMY SYNDROME ,[object Object]
POST LAMINECTOMY SYNDROME ,[object Object],[object Object],[object Object],[object Object],Spinal cord stimulator Intrathecal pump
Evidence based practices Outcome studies ,[object Object],[object Object],[object Object],www. pain india.net
ย 
ย 
ย 
ย 
ย 
ย 
ย 
ย 
ย 
ย 
ย 
Results & Gapes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thanks Thank you

More Related Content

What's hot

Ozone Nucleolysis vs Idet for Lumbar Disk
Ozone Nucleolysis vs Idet for Lumbar DiskOzone Nucleolysis vs Idet for Lumbar Disk
Ozone Nucleolysis vs Idet for Lumbar Disk
Kiran Jayswal
ย 
Interventional Pain Management
Interventional Pain ManagementInterventional Pain Management
Interventional Pain Management
Vaibhav Kamath
ย 
Management of neck pain
Management of neck painManagement of neck pain
Management of neck pain
yury
ย 

What's hot (20)

Back Pain
Back PainBack Pain
Back Pain
ย 
Ozone Nucleolysis vs Idet for Lumbar Disk
Ozone Nucleolysis vs Idet for Lumbar DiskOzone Nucleolysis vs Idet for Lumbar Disk
Ozone Nucleolysis vs Idet for Lumbar Disk
ย 
Interventional Pain Management
Interventional Pain ManagementInterventional Pain Management
Interventional Pain Management
ย 
Failed back surgery syndrome - A comprehensive overview
Failed back surgery syndrome  - A comprehensive overviewFailed back surgery syndrome  - A comprehensive overview
Failed back surgery syndrome - A comprehensive overview
ย 
Neck Pain Treatment
Neck Pain TreatmentNeck Pain Treatment
Neck Pain Treatment
ย 
Injections in Spine Practice: introductory concerns
Injections in Spine Practice:  introductory concernsInjections in Spine Practice:  introductory concerns
Injections in Spine Practice: introductory concerns
ย 
Discogenic back pain:Non-operative treatment by Dr Ashok Jadon,MD FIPP
Discogenic back pain:Non-operative treatment by Dr Ashok Jadon,MD FIPP Discogenic back pain:Non-operative treatment by Dr Ashok Jadon,MD FIPP
Discogenic back pain:Non-operative treatment by Dr Ashok Jadon,MD FIPP
ย 
Hip and spine syndrome (PMR)
Hip and spine syndrome (PMR)Hip and spine syndrome (PMR)
Hip and spine syndrome (PMR)
ย 
Disc regeneration
Disc regenerationDisc regeneration
Disc regeneration
ย 
Microscissor DREZ- A new technical modification
Microscissor DREZ- A new technical modificationMicroscissor DREZ- A new technical modification
Microscissor DREZ- A new technical modification
ย 
Laparoscopic retroperitoneal triple neurectomy
Laparoscopic retroperitoneal triple neurectomy Laparoscopic retroperitoneal triple neurectomy
Laparoscopic retroperitoneal triple neurectomy
ย 
Spinal cord injury
Spinal cord injurySpinal cord injury
Spinal cord injury
ย 
Lumbar Disc Herniation
Lumbar Disc Herniation Lumbar Disc Herniation
Lumbar Disc Herniation
ย 
Red flags of cervical pain
Red flags of cervical painRed flags of cervical pain
Red flags of cervical pain
ย 
entrapment neuropathies at elbow
entrapment neuropathies at elbowentrapment neuropathies at elbow
entrapment neuropathies at elbow
ย 
Low back pain
Low back painLow back pain
Low back pain
ย 
Management of neck pain
Management of neck painManagement of neck pain
Management of neck pain
ย 
Herniation of intervertbal disk
Herniation of intervertbal diskHerniation of intervertbal disk
Herniation of intervertbal disk
ย 
Cervical radicular pain
Cervical radicular painCervical radicular pain
Cervical radicular pain
ย 
Cervical radiculopathy
Cervical radiculopathyCervical radiculopathy
Cervical radiculopathy
ย 

Viewers also liked

Sanjoy-Chaki
Sanjoy-ChakiSanjoy-Chaki
Sanjoy-Chaki
Sanjoy Chaki
ย 
Good Class4 Ornamental Diseases
Good Class4 Ornamental DiseasesGood Class4 Ornamental Diseases
Good Class4 Ornamental Diseases
sherylwil
ย 
Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...
Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...
Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...
Heather Jordan
ย 
11 Pesticides
11 Pesticides11 Pesticides
11 Pesticides
sherylwil
ย 
Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...
Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...
Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...
Spark Summit
ย 
Varun das v s power point presentation on sericulture
Varun das v s   power point presentation on sericultureVarun das v s   power point presentation on sericulture
Varun das v s power point presentation on sericulture
mohanansoumya60
ย 

Viewers also liked (20)

Ipm overview
Ipm overviewIpm overview
Ipm overview
ย 
Managing spills
Managing spillsManaging spills
Managing spills
ย 
Sanjoy-Chaki
Sanjoy-ChakiSanjoy-Chaki
Sanjoy-Chaki
ย 
Good Class4 Ornamental Diseases
Good Class4 Ornamental DiseasesGood Class4 Ornamental Diseases
Good Class4 Ornamental Diseases
ย 
INSECT DEFENSE MECHANISM
INSECT DEFENSE MECHANISMINSECT DEFENSE MECHANISM
INSECT DEFENSE MECHANISM
ย 
Forest classification
Forest classificationForest classification
Forest classification
ย 
Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...
Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...
Genomic Analysis Of Nitrogen Fixation In Synechococcus Sp. PCC 7002 and Chlor...
ย 
Sericulture - A Detailed Study
Sericulture - A Detailed StudySericulture - A Detailed Study
Sericulture - A Detailed Study
ย 
11 Pesticides
11 Pesticides11 Pesticides
11 Pesticides
ย 
identification of ornamental plants
identification of ornamental plantsidentification of ornamental plants
identification of ornamental plants
ย 
Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...
Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...
Automated Machine Learning Using Spark Mllib to Improve Customer Experience-(...
ย 
Genetics Of Legume Rhizobium Symbiosis
Genetics Of Legume Rhizobium SymbiosisGenetics Of Legume Rhizobium Symbiosis
Genetics Of Legume Rhizobium Symbiosis
ย 
Cole Crops and Other Brassicas: Organic Production
Cole Crops and Other Brassicas: Organic ProductionCole Crops and Other Brassicas: Organic Production
Cole Crops and Other Brassicas: Organic Production
ย 
Idm practises on brassica vegetables
Idm practises on brassica vegetablesIdm practises on brassica vegetables
Idm practises on brassica vegetables
ย 
Genes
GenesGenes
Genes
ย 
Pesticide residue
Pesticide residuePesticide residue
Pesticide residue
ย 
Silkworm rearing technology
Silkworm rearing technologySilkworm rearing technology
Silkworm rearing technology
ย 
Varun das v s power point presentation on sericulture
Varun das v s   power point presentation on sericultureVarun das v s   power point presentation on sericulture
Varun das v s power point presentation on sericulture
ย 
Defense mechanism seminar
Defense mechanism seminarDefense mechanism seminar
Defense mechanism seminar
ย 
Rhizobium
RhizobiumRhizobium
Rhizobium
ย 

Similar to IPM

5 regional anesthesia
5 regional anesthesia5 regional anesthesia
5 regional anesthesia
Sumit Prajapati
ย 
Role of anaesthesiologist in management of cancer pain
Role of anaesthesiologist in management of cancer painRole of anaesthesiologist in management of cancer pain
Role of anaesthesiologist in management of cancer pain
DrUday Pratap Singh
ย 
Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)
Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)
Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)
yury
ย 
regional anesthesia and beir block
regional anesthesia and beir blockregional anesthesia and beir block
regional anesthesia and beir block
Ahmed Almumtin
ย 

Similar to IPM (20)

Neuro pain 60 mins
Neuro pain 60 minsNeuro pain 60 mins
Neuro pain 60 mins
ย 
Neuro pain 60 mins
Neuro pain 60 minsNeuro pain 60 mins
Neuro pain 60 mins
ย 
5 regional anesthesia
5 regional anesthesia5 regional anesthesia
5 regional anesthesia
ย 
Y maratos Image guided interventions of lumbar Spine jfim hanoi 2015
Y maratos Image guided interventions of lumbar Spine jfim hanoi 2015Y maratos Image guided interventions of lumbar Spine jfim hanoi 2015
Y maratos Image guided interventions of lumbar Spine jfim hanoi 2015
ย 
Interventional pain management
Interventional pain managementInterventional pain management
Interventional pain management
ย 
Neuraxial anaesthesia
Neuraxial anaesthesiaNeuraxial anaesthesia
Neuraxial anaesthesia
ย 
Cervical epidural
Cervical epiduralCervical epidural
Cervical epidural
ย 
pain ppt for undergraduates
 pain ppt for undergraduates pain ppt for undergraduates
pain ppt for undergraduates
ย 
ug class pain 7-12-22 (1).pptx
ug class pain 7-12-22 (1).pptxug class pain 7-12-22 (1).pptx
ug class pain 7-12-22 (1).pptx
ย 
Spinal cord stimulation
Spinal cord stimulation Spinal cord stimulation
Spinal cord stimulation
ย 
Spinal anaesthesia by dr. mohammad abss reshi
Spinal anaesthesia by dr. mohammad abss reshiSpinal anaesthesia by dr. mohammad abss reshi
Spinal anaesthesia by dr. mohammad abss reshi
ย 
Interventional spine & pain management dr manish raj
Interventional spine & pain management  dr manish rajInterventional spine & pain management  dr manish raj
Interventional spine & pain management dr manish raj
ย 
Role of anaesthesiologist in management of cancer pain
Role of anaesthesiologist in management of cancer painRole of anaesthesiologist in management of cancer pain
Role of anaesthesiologist in management of cancer pain
ย 
Cancer Pain: Introduction and Medical Management
Cancer Pain: Introduction and Medical ManagementCancer Pain: Introduction and Medical Management
Cancer Pain: Introduction and Medical Management
ย 
Interventional Pain Management In Cancer - P N Jain, MD MNAMS
Interventional Pain Management In Cancer - P N Jain, MD MNAMSInterventional Pain Management In Cancer - P N Jain, MD MNAMS
Interventional Pain Management In Cancer - P N Jain, MD MNAMS
ย 
Epidural anesthesia & analgesia
Epidural anesthesia & analgesiaEpidural anesthesia & analgesia
Epidural anesthesia & analgesia
ย 
Regional anesthesia
Regional anesthesiaRegional anesthesia
Regional anesthesia
ย 
Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)
Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)
Basics of acute and chronic pain medicine for the Otolaryngologist (ENT)
ย 
regional anesthesia and beir block
regional anesthesia and beir blockregional anesthesia and beir block
regional anesthesia and beir block
ย 
Cervical radiculopathy.pptx
Cervical radiculopathy.pptxCervical radiculopathy.pptx
Cervical radiculopathy.pptx
ย 

More from Ashok Jadon (8)

Blocked epidural catheter
Blocked epidural catheterBlocked epidural catheter
Blocked epidural catheter
ย 
Patho phsiology of pdph
Patho phsiology of pdphPatho phsiology of pdph
Patho phsiology of pdph
ย 
Epidural labour pain relief
Epidural labour pain reliefEpidural labour pain relief
Epidural labour pain relief
ย 
Intradiscal ozone and trans foraminal injections
Intradiscal ozone and trans foraminal injectionsIntradiscal ozone and trans foraminal injections
Intradiscal ozone and trans foraminal injections
ย 
Lumber plexus catheter and contrast
Lumber plexus catheter and contrastLumber plexus catheter and contrast
Lumber plexus catheter and contrast
ย 
Percutaneous Discectomy by Dr Ashok Jadon
Percutaneous Discectomy by Dr Ashok JadonPercutaneous Discectomy by Dr Ashok Jadon
Percutaneous Discectomy by Dr Ashok Jadon
ย 
Basics of radio frequency techniques in pain management jadon.a
Basics of radio frequency techniques in pain management  jadon.aBasics of radio frequency techniques in pain management  jadon.a
Basics of radio frequency techniques in pain management jadon.a
ย 
Modified stellate ganglion block
Modified stellate ganglion  blockModified stellate ganglion  block
Modified stellate ganglion block
ย 

Recently uploaded

Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...
Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...
Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...
chetankumar9855
ย 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
chennailover
ย 
๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...
๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...
๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...
Call Girls In Delhi Whatsup 9873940964 Enjoy Unlimited Pleasure
ย 
Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...
adilkhan87451
ย 

Recently uploaded (20)

Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
ย 
Premium Call Girls In Jaipur {8445551418} โค๏ธVVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} โค๏ธVVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} โค๏ธVVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} โค๏ธVVIP SEEMA Call Girl in Jaipur Ra...
ย 
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
ย 
Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...
Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...
Call Girl In Pune ๐Ÿ‘‰ Just CALL ME: 9352988975 ๐Ÿ’‹ Call Out Call Both With High p...
ย 
Call Girls Service Jaipur {9521753030 } โค๏ธVVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } โค๏ธVVIP BHAWNA Call Girl in Jaipur Raj...Call Girls Service Jaipur {9521753030 } โค๏ธVVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } โค๏ธVVIP BHAWNA Call Girl in Jaipur Raj...
ย 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
ย 
Call Girls Varanasi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 8250077686 Top Class Call Girl Service Available
ย 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur โฃ 8445551418 โฃ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur โฃ 8445551418 โฃ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur โฃ 8445551418 โฃ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur โฃ 8445551418 โฃ Elite Models & Ce...
ย 
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
ย 
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
ย 
๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...
๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...
๐ŸŒนAttapurโฌ…๏ธ Vip Call Girls Hyderabad ๐Ÿ“ฑ9352852248 Book Well Trand Call Girls In...
ย 
Call Girls in Delhi Triveni Complex Escort Service(๐Ÿ”))/WhatsApp 97111โ‡›47426
Call Girls in Delhi Triveni Complex Escort Service(๐Ÿ”))/WhatsApp 97111โ‡›47426Call Girls in Delhi Triveni Complex Escort Service(๐Ÿ”))/WhatsApp 97111โ‡›47426
Call Girls in Delhi Triveni Complex Escort Service(๐Ÿ”))/WhatsApp 97111โ‡›47426
ย 
8980367676 Call Girls In Ahmedabad Escort Service Available 24ร—7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24ร—7 In Ahmedabad8980367676 Call Girls In Ahmedabad Escort Service Available 24ร—7 In Ahmedabad
8980367676 Call Girls In Ahmedabad Escort Service Available 24ร—7 In Ahmedabad
ย 
Top Rated Pune Call Girls (DIPAL) โŸŸ 8250077686 โŸŸ Call Me For Genuine Sex Serv...
Top Rated Pune Call Girls (DIPAL) โŸŸ 8250077686 โŸŸ Call Me For Genuine Sex Serv...Top Rated Pune Call Girls (DIPAL) โŸŸ 8250077686 โŸŸ Call Me For Genuine Sex Serv...
Top Rated Pune Call Girls (DIPAL) โŸŸ 8250077686 โŸŸ Call Me For Genuine Sex Serv...
ย 
Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call ๐Ÿ‘‰๐Ÿ‘‰7877925207 Top Class Call Girl Service Avai...
ย 
Call Girls Kolkata Kalikapur ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ Top Class Call Girl Se...
Call Girls Kolkata Kalikapur ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ Top Class Call Girl Se...Call Girls Kolkata Kalikapur ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ Top Class Call Girl Se...
Call Girls Kolkata Kalikapur ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ Top Class Call Girl Se...
ย 
Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510
ย 
Call Girls Service Jaipur {8445551418} โค๏ธVVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} โค๏ธVVIP BHAWNA Call Girl in Jaipur Raja...Call Girls Service Jaipur {8445551418} โค๏ธVVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} โค๏ธVVIP BHAWNA Call Girl in Jaipur Raja...
ย 
Call Girls Mumbai Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Mumbai Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 8250077686 Top Class Call Girl Service Available
ย 
Independent Call Girls In Jaipur { 8445551418 } โœ” ANIKA MEHTA โœ” Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } โœ” ANIKA MEHTA โœ” Get High Prof...Independent Call Girls In Jaipur { 8445551418 } โœ” ANIKA MEHTA โœ” Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } โœ” ANIKA MEHTA โœ” Get High Prof...
ย 

IPM

Editor's Notes

  1. What are the structures and their pathology responsible for low back pain