What is the fundamental definition of neuralgia according to the provided text?

Neuralgia is defined as pain that occurs within the distribution of a nerve or nerves. This means the pain follows the path of a specific nerve or group of nerves in the body.

What is the etymological origin of the term 'neuralgia'?

The term 'neuralgia' originates from Greek words: 'neuron,' meaning 'nerve,' and 'algos,' meaning 'pain.' Thus, it literally translates to 'nerve pain.'

Can you provide examples of specific types of neuralgia mentioned in the text?

Yes, the text mentions several specific types of neuralgia, including intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal neuralgia.

How does neuralgia differ from neuropathic pain as described in the article?

While neuralgia refers to pain in the distribution of a nerve, neuropathic pain is a broader term for pain caused by a lesion or disease of the somatosensory nervous system. Neuralgia can be a symptom or type of neuropathic pain, but the distinction is important for diagnosis and treatment.

What are some of the specific types of neuralgia listed under the general classification?

Under the general heading of neuralgia, the text lists trigeminal neuralgia (TN), atypical trigeminal neuralgia (ATN), occipital neuralgia, glossopharyngeal neuralgia, and postherpetic neuralgia. It also notes that neuralgia can refer to pain associated with sciatica and brachial plexopathy.

What is postherpetic neuralgia caused by?

Postherpetic neuralgia is specifically caused by shingles, which is a viral infection, or other forms of herpes.

What characterizes atypical trigeminal neuralgia (ATN)?

Atypical trigeminal neuralgia (ATN) is a rare and often misdiagnosed form of neuralgia. Its symptoms can be varied, including mild aching, burning, or crushing sensations, and it may present as a constant migraine-like headache affecting all three branches of the trigeminal nerve. Pain can also occur in the back of the scalp and neck, and it is often triggered by actions like talking, facial expressions, chewing, or even a cool breeze.

What conditions can symptoms of atypical trigeminal neuralgia (ATN) be mistaken for?

The symptoms of ATN can be mistaken for migraines, dental problems like temporomandibular joint disorder, musculoskeletal issues, and even hypochondriasis, making it prone to misdiagnosis.

Which nerves are affected in typical trigeminal neuralgia (TN), and what sensations do they control?

In typical trigeminal neuralgia, the affected nerves are branches of the trigeminal nerve. These nerves are responsible for sensing touch, temperature, and pressure in the facial area, extending from the jaw up to the forehead.

How is the pain of typical trigeminal neuralgia (TN) typically described?

The pain associated with typical trigeminal neuralgia is often described as excruciating and typically occurs in short episodes, usually lasting less than two minutes. Common descriptions include 'stabbing,' 'sharp,' 'like lightning,' 'burning,' and sometimes even 'itchy.'

What is the key difference in pain presentation between typical and atypical trigeminal neuralgia?

Typical trigeminal neuralgia is characterized by short, sharp, excruciating episodes of pain, while the atypical form presents as a more constant, severe aching sensation along the nerve pathway.

What does the term 'tic douloureux' refer to in the context of trigeminal neuralgia?

'Tic douloureux' is an older term for trigeminal neuralgia, originating from French. 'Tic' refers to a spasm, and 'douloureux' means painful, reflecting the sudden, painful muscle spasms that can accompany the condition.

What are the typical symptoms and location of pain in glossopharyngeal neuralgia?

Glossopharyngeal neuralgia involves recurring attacks of severe pain located in the back of the throat, near the tonsils, the back of the tongue, and a part of the ear. This pain arises from the malfunction of the glossopharyngeal nerve (CN IX).

What is the glossopharyngeal nerve (CN IX) responsible for?

The glossopharyngeal nerve (CN IX) is responsible for moving the muscles of the throat and for transmitting sensory information from the throat, tonsils, and tongue to the brain.

What are the common causes of glossopharyngeal neuralgia?

Often, the cause of glossopharyngeal neuralgia is unknown. However, it can sometimes result from an abnormally positioned artery compressing the glossopharyngeal nerve near the brainstem, or less commonly, from a tumor in the brain or neck.

What are the defining characteristics of occipital neuralgia?

Occipital neuralgia, also known as C2 neuralgia or Arnold's neuralgia, is characterized by chronic pain experienced in the upper neck, the back of the head, and behind the eyes.

How do researchers believe hyperexcitability in the nervous system relates to neuropathic pain?

Researchers believe that neuroplastic changes occurring after nerve damage can lead to hyperexcitability in the nervous system. This hyperexcitability is thought to be the underlying mechanism causing neuropathic pain.

What are the three classifications of nerve injury according to Seddon's classification?

Seddon's classification describes nerve injury in three categories: neurapraxia, axonotmesis, and neurotmesis. These classifications help determine the severity and potential for recovery after nerve trauma.

What is 'injury discharge' and what is its potential link to neuropathic pain?

'Injury discharge' refers to a short onset of afferent impulses that occur immediately following trauma to a nerve. This phenomenon, lasting only a few minutes, has been linked to the subsequent onset of neuropathic pain.

Describe the process of axon degeneration and regeneration following a nerve injury.

When an axon is severed, the part distal to the cut degenerates and is absorbed by Schwann cells. The proximal segment forms a 'retraction bulb,' and axoplasmic transport ceases, halting neurotransmitter production. Schwann cells and the basal lamina then guide regeneration, but if connections are not made correctly, aberrant reinnervation or neuroma formation can occur.

What can happen if an injured neuron does not regenerate properly?

If an injured neuron degenerates or fails to regenerate correctly, it can lose its function or malfunction. This malfunction can lead to abnormal signals being sent to the brain, which may be interpreted as pain. Neuron trauma can also affect surrounding neurons, causing a cascade of issues.

What are the essential components for diagnosing neuralgia?

Diagnosing neuralgia requires a thorough patient history detailing the pain, a description of the pain itself, a physical examination, and potentially experimental examinations to assess nerve function.

How can pain assessment questionnaires aid in the evaluation of neuralgia?

While pain is subjective, questionnaires like the McGill Pain Questionnaire can be valuable tools for clinicians to systematically evaluate and quantify a patient's pain experience, aiding in diagnosis and treatment planning.

What types of stimuli are typically tested during a physical examination for neuralgia?

During a physical examination for neuralgia, clinicians typically test the patient's responses to stimuli such as touch, temperature, and vibration to assess nerve function and identify potential areas of dysfunction.

How can the response to treatment be used in diagnosing neuralgia?

The way a patient's pain responds to different treatments can serve as a final diagnostic tool to help determine the underlying mechanism of the pain, guiding further therapeutic decisions.

What are Laser Evoked Potentials (LEPs) and how are they used in diagnosing nerve issues?

Laser Evoked Potentials (LEPs) are measurements of brain responses to laser-induced stimuli on the skin. By using lasers to selectively activate specific nerve endings (thermonociceptors), abnormalities in LEPs can indicate neuropathic pain or damage to the central and peripheral nervous systems.

What is Quantitative Sensory Testing (QST) and what does it measure?

Quantitative Sensory Testing (QST) is a method used to assess nerve function by measuring a patient's response to controlled external stimuli. It quantifies sensitivity to mechanical stimuli (like touch and pressure), thermal stimuli (temperature), and vibration.

What types of medications are typically effective for treating neuralgia?

Neuralgia is often treated with medications that stabilize nerve membranes, such as certain antiepileptic drugs like pregabalin (Lyrica) and gabapentin (Neurontin), and tricyclic antidepressants. These medications work by blocking abnormal nerve firing.

When might surgical treatment be considered for neuralgia?

Surgical treatment for neuralgia is typically considered if medications fail to provide adequate pain relief or if the side effects of medication become intolerable.

What is the goal of neural augmentative surgeries for neuralgia?

Neural augmentative surgeries aim to stimulate the affected nerve, essentially 'fooling' the brain into perceiving normal input. This is achieved by placing electrodes near the nerve to deliver electrical stimulation, which can be adjusted to optimize pain relief.

What are some potential risks or side effects associated with surgical treatments for neuralgia?

Surgical interventions for neuralgia can carry risks such as facial numbness, potential recurrence of pain, hearing loss, balance problems, infection, and even stroke, depending on the specific procedure.

What are two specific surgical procedures mentioned for treating neuralgia?

Two surgical procedures mentioned for treating neuralgia are rhizotomy, which involves destroying select nerve fibers to block pain, and microvascular decompression, where compressing blood vessels are moved away from the affected nerve.

When was the term 'nèvralgie' first cited, and who coined it?

The term 'nèvralgie' (the French term for neuralgia) was first cited in 1801 by François Chaussier, who defined it as an affection of one or more nerves causing intermittent but often intense pain.

How did the understanding of the location of the primary lesion in neuralgia evolve during the 19th century?

During the 19th century, the proposed location for the primary lesion causing neuralgia shifted over time. Initially, it was thought to be in the nerve roots, ganglia, trunks, or branches. Later, some theories suggested the spinal cord or nerve root, while others proposed it could be an affliction of organs like the uterus or liver, or even linked to emotional distress.

How has neuralgia been depicted in literature and film?

Neuralgia has been featured in various cultural works. For instance, in R. C. Sherriff's play 'Journey's End' and the film 'Aces High,' characters feign neuralgia to avoid duty. Marcel Proust's 'Swann's Way' mentions the narrator's father suffering from it, and Vladimir Nabokov's 'Look at the Harlequins!' includes a character with neuralgia of the jaw.

What are the ICD-10 and ICD-9-CM codes associated with neuralgia?

According to the provided text, the ICD-10 code for neuralgia is M79.2, and the ICD-9-CM code is 729.2.

What is the MeSH descriptor for neuralgia?

The Medical Subject Headings (MeSH) descriptor for neuralgia is D009437.

What does the term 'intercostal neuralgia' refer to?

Intercostal neuralgia refers to pain occurring in the distribution of the intercostal nerves, which run between the ribs.

What is the primary characteristic of glossopharyngeal nerve (CN IX) malfunction in glossopharyngeal neuralgia?

In glossopharyngeal neuralgia, the malfunction of the glossopharyngeal nerve (CN IX) leads to recurring attacks of severe pain in specific areas of the throat, near the tonsils, the back of the tongue, and part of the ear.

What is the significance of 'aberrant reinnervation' in the context of nerve regeneration?

Aberrant reinnervation occurs when a regenerating axon fails to connect to its appropriate receptors. This can lead to improper nerve function or the development of abnormal sensations, potentially contributing to chronic pain conditions.

What role do Schwann cells play in nerve regeneration?

Schwann cells play a crucial role in nerve regeneration. They line the nerve and, along with the basal lamina they secrete, help guide and stimulate the regrowth of the damaged axon's proximal segment towards its original target.

What is the purpose of using 'injury discharge' in understanding neuropathic pain?

Understanding 'injury discharge,' the brief burst of nerve impulses immediately following trauma, helps researchers explore the mechanisms that might trigger the development of neuropathic pain, particularly the hyperexcitability of the nervous system.

How can a cool breeze trigger pain in some forms of neuralgia?

In certain types of neuralgia, like atypical trigeminal neuralgia, even a light sensation such as a cool breeze can trigger an attack. This sensitivity is due to the altered nerve signaling characteristic of the condition.

What is the relationship between 'tic douloureux' and trigeminal neuralgia?

'Tic douloureux' is an older French term for trigeminal neuralgia, highlighting the spasmodic and painful nature of the condition.

What is the main challenge in treating neuralgia compared to other types of pain?

Neuralgia is generally more difficult to treat effectively with standard pain medications because it often does not respond well to them. Specialized medications targeting nerve function are typically required.

What is the function of the trigeminal nerve in relation to facial sensation?

The trigeminal nerve is responsible for transmitting sensory information from the face to the brain, including sensations of touch, temperature, and pressure, covering areas from the jaw to the forehead.

What does the term 'neuroma' signify in the context of nerve injury?

A neuroma is a mass of nerve tissue that can form when a regenerating axon is halted by damaged tissue or scar tissue. It can sometimes be a source of persistent pain.

Neuralgia Wiki: Neuralgia Unveiled: A Deep Dive into Nerve Pain Dynamics

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Definition

Origin of the Term

The term "neuralgia" originates from the Greek words neuron (nerve) and algos (pain). It precisely describes pain that occurs within the anatomical distribution of a nerve or nerves.^[1] This distinguishes it from other types of pain and highlights its neurological basis.

Characterizing Nerve Pain

Neuralgia is characterized by pain experienced along the pathway of a damaged or dysfunctional nerve. Examples include intercostal neuralgia (affecting nerves between the ribs) and trigeminal neuralgia (affecting the trigeminal nerve in the face).^[1] It is important to differentiate neuralgia from neuropathic pain, which is a broader category encompassing pain arising from lesions or diseases of the somatosensory nervous system.

Classification

Diverse Manifestations

Neuralgia encompasses several distinct conditions, often categorized by the affected nerve or specific symptom presentation. Understanding these classifications is crucial for accurate diagnosis and targeted treatment.

Trigeminal Neuralgia (TN)

This condition affects the trigeminal nerve, responsible for facial sensation. It typically presents as short, excruciating episodes of sharp, stabbing, or electric shock-like pain, usually unilateral, triggered by simple stimuli like touch or chewing. The pain can be described as intense and debilitating.^[2]

Atypical Trigeminal Neuralgia (ATN)

ATN is a rarer, often misdiagnosed form. Symptoms can be more varied, including constant aching, burning sensations, and migraine-like headaches affecting all three trigeminal branches. Pain may worsen with facial expressions, chewing, or even a cool breeze. Potential causes include vascular compression of the nerve, infections, or trauma.^[2]

Glossopharyngeal Neuralgia

This rare neuralgia affects the glossopharyngeal nerve (CN IX), causing recurrent, severe pain in the throat, tonsil area, back of the tongue, and ear. It typically occurs after age 40, more often in men. Causes can be unknown, but may involve nerve compression by an artery or, rarely, a tumor.^[2]

Occipital Neuralgia

Also known as C2 neuralgia or Arnold's neuralgia, this condition is characterized by chronic pain in the upper neck, the back of the head, and behind the eyes. It stems from irritation or inflammation of the occipital nerves.^{[Citation Needed]}

Postherpetic Neuralgia

This type of neuralgia occurs as a complication of shingles (herpes zoster) or herpes infections. It involves persistent nerve pain following the initial rash, often described as burning, stabbing, or aching.^{[Citation Needed]}

Mechanisms

Nerve Injury and Response

Neuralgia often arises from damage or injury to peripheral nerves. The nervous system's response to trauma can lead to hyperexcitability, a key factor in neuropathic pain and neuralgia.^[3]

Cellular Changes Post-Injury

Following nerve trauma, an "injury discharge" of nerve impulses can occur, potentially initiating neuropathic pain.^[4] If an axon is severed, the distal segment degenerates, while the proximal segment attempts regeneration. Aberrant reinnervation or neuroma formation (a mass of neurofibrils) can result if regeneration is impaired or misdirected, leading to persistent pain signals.^[4]

Neuroplasticity and Maladaptive Signaling

The nervous system's ability to adapt (neuroplasticity) can become maladaptive in cases of nerve injury. Damaged or degenerated neurons may send abnormal signals to the brain, which are then interpreted as pain, even in the absence of ongoing tissue damage.^[4]

Diagnosis

Clinical Assessment

Diagnosing neuralgia relies heavily on a detailed patient history, including the description, location, intensity, and triggers of the pain. Standardized pain assessment questionnaires, such as the McGill Pain Questionnaire, can aid in quantifying the subjective experience.^[5] A thorough physical examination assesses responses to various stimuli like touch, temperature, and vibration.

Advanced Diagnostic Tools

While clinical assessment is primary, specialized tests can provide further insights:

Laser Evoked Potentials (LEPs): Measure cortical responses to laser-stimulated thermonociceptors, potentially indicating damage to the central or peripheral nervous system.^[6]
Quantitative Sensory Testing (QST): Systematically evaluates a patient's response to controlled mechanical and thermal stimuli to quantify sensory nerve function.^[7]

Treatment response can also serve as a diagnostic tool to confirm the underlying mechanism of pain.^[3]

Classification Codes

Neuralgia is classified under various medical coding systems:

ICD-10: M79.2
ICD-9-CM: 729.2
MeSH: D009437

Treatment

Pharmacological Approaches

Neuralgia often requires specialized medications due to its resistance to standard pain relievers. Effective treatments typically include:

Anticonvulsants: Medications like pregabalin (Lyrica) and gabapentin (Neurontin) are specifically designed to block nerve firing and manage neuropathic pain.^{[Citation Needed]}
Antidepressants: Certain antidepressants, such as duloxetine (Cymbalta), can also modulate pain pathways.^{[Citation Needed]}

High doses of these medications are often necessary, and tricyclic antidepressants may also be employed.^[8]

Surgical Interventions

When medications fail or cause intolerable side effects, surgical options may be considered. These aim to modulate or decompress the affected nerve:

Nerve Stimulation: Surgical placement of electrodes to stimulate the nerve, potentially altering pain signals sent to the brain.
Rhizotomy: Selective destruction of nerve fibers to block pain transmission.
Microvascular Decompression: Relocating blood vessels that may be compressing the affected nerve.

Potential risks associated with surgery include temporary or permanent numbness, recurrence of pain, hearing loss, balance issues, infection, and stroke.^[10]

History

Evolution of Understanding

The term "neuralgia" emerged in the early 19th century, with French physician François Chaussier coining the term névralgie in 1801 to describe intermittent, intense nerve pain.^[11] Throughout the 19th century, the understanding of its location and cause evolved significantly.

Early theories proposed lesions in nerve roots, ganglia, trunks, or even the brain and spinal cord.^[13] Some physicians attributed neuralgia to general ill health or "morbid sensibility," while others linked it to specific organs or emotional distress.^[13] The concept has continuously been refined as medical understanding advanced.

Culture & Representation

In Literature and Film

Neuralgia has appeared in various cultural works, often depicted as a debilitating condition or a convenient ailment used for dramatic effect:

In R. C. Sherriff's play Journey's End, a character feigns neuralgia to avoid combat duty.^[17]
Marcel Proust's Swann's Way mentions the narrator's father suffering from neuralgia.^[18]
The film Aces High features a pilot simulating neuralgia to escape the dangers of aerial warfare.^[19]
Vladimir Nabokov's novel Look at the Harlequins! includes a character claiming to have neuralgia of the jaw.^[20]

Related Conditions

Neurological Connections

Neuralgia is closely related to various conditions affecting the nervous system. Understanding these connections aids in differential diagnosis and comprehensive patient care.

References

Source Material

The information presented on this page is derived from the following sources:

"IASP Terminology: neuralgia". International Association for the Study of Pain. Retrieved 15 Nov 2023.
Gilron, I.; Watson, C. P. N.; Cahill, C. M.; Moulin, D. E. (2006). "Neuropathic pain: a practical guide for the clinician". Canadian Medical Association Journal. 175 (3): 265–275. PMC 1513412. PMID 16880448.
Jensen, T. S. (2002). "An improved understanding of neuropathic pain". European Journal of Pain. 6 (Supplement). London: 3–11. doi:10.1016/S1090-3801(02)90002-9. PMID 23570142. S2CID 12760893.
P. Prithvi Raj (14 June 2000). Practical Management of Pain. Mosby. ISBN 978-0-8151-2569-3.
Melzack, R. (1975). "The McGill Questionnaire: Major Properties and Scoring Methods". Pain. 1 (3): 277–299. doi:10.1016/0304-3959(75)90044-5. PMID 1235985. S2CID 20562841.
Garcia-Larrea, L. (2008). "Laser-evoked potentials in the diagnosis of central neuropathic pain". Douleur et Analgésie. 21 (2): 93–98. doi:10.1007/s11724-008-0092-5. S2CID 70895743.
Daniel, H. C.; Narewska, J.; Serpell, M.; Hoggart, B.; Johnson, R.; Rice, A. S. C. (2008). "Comparison of psychological and physical function in neuropathic pain and nociceptive pain: Implications for cognitive behavioral pain management programs". European Journal of Pain. 12 (6): 731–741. doi:10.1016/j.ejpain.2007.11.006. PMID 18164225. S2CID 28750350.
Stechison, Michael. Personal INTERVIEW. 18 November 2008.
Galer, B. S. (1995). "Neuropathic pain of peripheral origin: Advances in pharmacologic treatment". Neurology. 45 (129): S17 – S25. doi:10.1212/WNL.45.12_Suppl_9.S17. PMID 8538882. S2CID 38518116.
Dworkin, R. H.; Backonja, M.; Rowbotham, M. C.; Allen, R. R.; Argoff, C. R.; Bennett, GJ; Bushnell, MC; Farrar, JT; et al. (2003). "Advances in neuropathic pain - Diagnosis, mechanisms, and treatment recommendations". Archives of Neurology. 60 (11): 1524–1534. doi:10.1001/archneur.60.11.1524. PMID 14623723.
Murray JAH. Bradley H; Craigie WA; Onions CT (1933). Oxford English Dictionary. Clarendon Press.
Richard Rowland (1838). A treatise on neuralgia. p. 3. Retrieved 5 August 2012.
Alam C & Merskey H (1994). "What's in a name? The cycle of change in the meaning of neuralgia". History of Psychiatry. 5 (20): 429–474. doi:10.1177/0957154x9400502001. PMID 11639457. S2CID 11856642.
Warren JC (19 February 1928). "Cases of neuralgia or painful afflictions of the nerves". Boston Med. Surg. J. (i): 1–6.
Graham TJ (1928). Treatise on indigestion. London: W. Joy. pp. 256–7.
Teale TP (1830). A treatise on neuralgic diseases. Philadelphia: E. L. Carey & A. Hart.
Sherriff, Robert Cedric (1983). Journey's end. Harmondsworth: Penguin. pp. 53–58. ISBN 0-14-118326-8.
Proust, Marcel (1913–1927). "Overture". Swann's Way. Penguin. ISBN 978-0-14-118058-8. "my father...had begun to suffer from neuralgia..."
Aces High. 1976. Event occurs at 12:39.
Nabokov, Vladimir (1974). "5". Look at the Harlequins!.

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References

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This is not medical advice. The information provided on this website is not a substitute for professional medical consultation, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition like neuralgia. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Neuralgia Unveiled

💡 Dive in with Flashcard Learning! 💡

Definition 🩺

⚡ Origin of the Term

⚠️ Characterizing Nerve Pain

Classification 🗂️

🤔 Diverse Manifestations

⚡ Trigeminal Neuralgia (TN)

Atypical Trigeminal Neuralgia (ATN)

👂 Glossopharyngeal Neuralgia

⬆️ Occipital Neuralgia

🩹 Postherpetic Neuralgia

Mechanisms ⚙️

💥 Nerve Injury and Response

🔬 Cellular Changes Post-Injury

🔄 Neuroplasticity and Maladaptive Signaling

Diagnosis 🔍

🗣️ Clinical Assessment

💡 Advanced Diagnostic Tools

📊 Classification Codes

Treatment 💊

🧑‍⚕️ Pharmacological Approaches

🔪 Surgical Interventions

History 📜

🕰️ Evolution of Understanding

Culture & Representation 🎭

📚 In Literature and Film

Related Conditions 🔗

➡️ Neurological Connections

Peripheral Nervous System Disorders

Pain Syndromes & Concepts

References 📚

📖 Source Material

Teacher's Corner 🧑‍🏫

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📜 References

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Disclaimer ⚠️

📜 Important Notice

Dive in with Flashcard Learning!

Definition

Origin of the Term

Characterizing Nerve Pain

Classification

Diverse Manifestations

Trigeminal Neuralgia (TN)

Glossopharyngeal Neuralgia

Occipital Neuralgia

Postherpetic Neuralgia

Mechanisms

Nerve Injury and Response

Cellular Changes Post-Injury

Neuroplasticity and Maladaptive Signaling

Diagnosis

Clinical Assessment

Advanced Diagnostic Tools

Classification Codes

Treatment

Pharmacological Approaches

Surgical Interventions

History

Evolution of Understanding

Culture & Representation

In Literature and Film

Related Conditions

Neurological Connections

References

Source Material

Teacher's Corner

True or False?

Test Your Knowledge!

Gamer's Corner

Discover other topics to study!

References

Feedback & Support

Disclaimer

Important Notice