 So chronic pain is pain that is in any part of the body or multiple parts of the body that has been lasting for more than six months. So what causes chronic pain can be a variety of different things everything from an autoimmune condition which means your body's own response against itself to an injury or a side effect of medications or side effect from other conditions such as obesity. So symptoms of chronic pain can be anything from an ache to a burning sensation to stabbing shooting pain and it definitely ranges in severity and a patient can have a good day, a bad day and it's definitely related to the weather. So many of my patients are able to tell me they know when it's going to rain or they know when things just aren't right with their body and even though their pain may not be as severe as other patients or they may feel pain differently that doesn't mean that they're not in pain. Managing chronic pain is a very challenging thing not only as a physician but for patients also and their families. Most of my patients don't want to be labeled as chronically ill or a drug seeker or any of those negative things that can be associated with having chronic pain. So my job as a physician is to help patients navigate the health care system and also understand what resources are available to them outside of the health care system and then utilizing all sorts of different modalities for pain relief whether it is starting a physical therapy program, chiropractic care, acupuncture, acupressure but then also very important to tie in diet to their everyday life and how that affects their pain. So as we know there is a very big opioid epidemic in this country so my philosophy with treating pain is to sit down with my patients get a detailed history as to what their pain is what they're feeling how the pains affected their daily life and then seeing what workup has been done in the past whether it's MRIs and x-rays and things of that nature and what medications they've tried in the past and what medications worked in the past. A lot of my patients I don't want them on long-term narcotics I don't want them on long-term medications but sometimes we need to do medications to help get them started with a physical therapy program or get them a bridge to a longer-term solution whether it's working with pain management whether they are going to be considered for injection-based therapy or risotomy or spinal cord stimulators. My job is to help them navigate that pipeline because there are so many options and understanding that not every patient fits the same pattern and what works for one patient might not work for another patient so it's very challenging.