Increasing Neck Pain, Low Libido, Weight Gain – Maybe Your Opioid Medication Is to Blame?

/2,087 Comments/in , , /by

low testosterone opioids and chronic neck pain

Symptoms of chronic pain or signs of OPIAD?

The sharp rise in the use of opioids for pain management in recent years has also led to an increase in opioid induced androgen deficiency. However, awareness of this condition remains poor and so many patients with chronic neck pain are suffering with symptoms of low libido, weight gain, fatigue, and depression that may be treatable with androgen replacement therapy. Is low testosterone to blame for your symptoms? Are your pain medications to blame for your low testosterone?

Improving Symptoms of Chronic Illness with Testosterone Therapy

Results of a study presented at the ENDO 2013: the Endocrine Society 95th Annual Meeting in June suggest that patients with opioid induced androgen deficiency (OPIAD) may be able to reduce both pain and reliance on pain medications through androgen replacement therapy. Men suffering from testosterone deficiency brought on by chronic use of opioids were given a transdermal gel to use for three months in order to boost testosterone, with the results showing that this helped improve pain tolerance compared to placebo.

Androgens and Signs of Deficiency

Testosterone deficiency has also been seen to affect pain response in animal studies with supplementation increasing rats’ capacity to tolerate pain. This is the first human study showing similar effects and it may help highlight the increasing prevalence of insufficient androgen production in patients with chronic pain conditions.

Androgens are sex hormones, including testosterone, that rely on sufficient levels of gonadotropins (follicle stimulating hormone and luteinizing hormone) to be produced. Gonadotropins can be adversely affected by opioids, leading to lower levels of sex hormone production and symptoms of low testosterone. Both men and women can suffer the effects of OPIAD with symptoms including:


  • Reduced libido
  • erectile dysfunction
  • fatigue
  • hot flashes
  • depression
  • reduction in facial and body hair
  • anemia
  • decreased muscle mass
  • weight gain
  • osteopenia or osteoporosis
  • infertility

Diagnosing OPIAD in Patients with Chronic Pain

Low testosterone connected to long-term opioid use in conditions such as neck pain is not always easy to spot. This is because many of the physical and emotional effects of chronic degenerative spine diseases, as well as the after-effects of neck trauma or neck surgery, can appear similar to symptoms of low levels of circulating androgens. Patients may feel that their symptoms are a normal response to a traumatic experience or a chronic illness and simply not report them to their physician. Many physicians may lack knowledge of OPIAD and, unfortunately, dismiss patients’ symptoms as a typical set of effects connected to chronic ill health.

Dismissing Symptoms of OPIAD

When neck pain affects a person’s ability to exercise, work, and socialize, it may be seen as inevitable that that person will become depressed, overweight, and have issues with their libido and energy levels. That this is not always the case has, however, been illustrated by a study published just last week that found that men taking opioids for back pain were about 50% more likely to fill out a prescription for drugs for erectile dysfunction than men with back pain who were not taking opioid medications.

OPIAD in women

Testing and Treating Androgen Deficiency

Patients are unlikely, and ill-advised to simply cease taking pain medications to see if their symptoms of OPIAD improve. Luckily, blood tests can determine if free and total testosterone levels are abnormally low and patients may then be offered androgen replacement therapy to address the issue. Increasingly, physicians are encouraged to monitor patients taking opioids long-term for signs of OPIAD and to work with patients to prevent severe symptoms arising. Women with OPIAD will likely be prescribed dehydroepiandrosterone (DHEA) while men will be prescribed testosterone to restore functional sex hormone levels and, according to this latest research, this may also help improve pain tolerance and allow them to reduce their use of opioids.

Risks and Benefits of Androgen Replacement Therapy

There are some risks of androgen replacement therapy, however, such as prostate disease in men and so patients are not recommended to pursue self-treatment with DHEA or testosterone using store bought products or medications purchased over the internet. Careful monitoring by a qualified physician needs to be carried out to reduce risks and manage symptoms. The use of androgen replacement therapy has not been well studied in women and benefits may be marginal with some potential side effects including hirsutism, acne, polycythaemia, increased high-density lipoproteins and risk of cardiovascular disease, and endometrial hyperplasia. However, some benefits that have been reported include: improved libido, increasing initiation and enjoyment of sex, and enhanced ability to reach orgasm. Patients in this latest study also reported improvements in emotional symptoms affecting their daily quality of life.

Those suffering with neck pain who have found that opioid pain medications are decreasingly effective at managing their pain and who are experiencing symptoms that may indicate opioid induced androgen insufficiency are encouraged to discuss their concerns with their doctor.

References

ENDO 2013: the Endocrine Society’s 95th Annual Meeting. Abstract LB-FP-6, presented June 15, 2013.

Smith HS, Elliott JA. Opioid-induced androgen deficiency (OPIAD). Pain Physician. 2012 Jul;15(3 Suppl):ES145-56.

Deyo, R.A., Smith, D.H., Johnson, E.S., Tillotson, C.J., Donovan, M., Yang, X., Petrik, A., Morasco, B.J., Dobscha, S., Prescription Opioids for Back Pain and Use of Medications for Erectile Dysfunction,

Spine, Volume 38 – Issue 11 – p 909–915.

Eden, K.J., and Wylie, K.R. (2009). Quality of sexual life and menopause. Women’s Health, 5 (4), 385-396.

Nappi, R.E. et al., (2006). Clitoral stimulation in postmenopausal women with sexual dysfunction: A pilot randomized study with hormone therapy. European Menopause Journal, 55, 288-295

You might also like
Early Treatment for a Pinched Nerve in the Neck
Medical Marijuana for Chronic Neck Pain - Reducing the Risk of Opioid Overdose
Neck Pain and Gum Disease - Are They Connected?
Causes of Neck and Shoulder Pain
TMJ, Ear and Neck Pain
Candida and Neck Pain - Is There a Connection?
Can Statins Cause Neck Pain?
Common Causes of Neck Pain in the Elderly
2087 replies
  1. gianafa
    gianafa says:

    To utilize ERAM and know how you can set it up, you can visit its official website.

    The software from the Networx team is known to create a large number of new registries and/or keys to increase its efficiency. That isn’t the only feature the software offers, either. It’s also believed that most people do not use its advanced functionality in full.
    An instance of its main window.
    If you select a newly discovered registry, you are able https://turkishbazaar.us/wp-content/uploads/2022/06/Display_Loaded_Modules.pdf
    50e0806aeb gianafa

    Reply
  2. teyajim
    teyajim says:

    Finding a tool to back up your files is something you generally have to do, occasionally or when moving your device to a different platform, and more frequently during an upgrade. There are many different products to choose from, some with features that set them apart and some that just simply try to be as comprehensive as possible. Files Pro is one of those tools, following the same concept as other similar products, but with a bit more advanced approach as well. Does it work? Read our review in http://www.studiofratini.com/dvr-studio-free-download-for-pc/
    50e0806aeb teyajim

    Reply
  4. dacldaws
    dacldaws says:

    Microsoft to start open sourcing OS X at WWDC

    ‘We’re very happy for Apple to have such attention around the new Mac operating systems’

    Common Topics

    Microsoft has announced that it will make the source code for its Mac operating system available under the open source licence next week at the Worldwide Developers Conference.

    “We’re very happy for Apple to have such attention around the new Mac operating systems,” a Microsoft spokesperson told the Wall Street Journal. http://descargatelo.net/uncategorized/hotspot-crack-keygen-download-for-pc/
    50e0806aeb dacldaws

    Reply
  5. jamvada
    jamvada says:

    How to increase UPS folder size or reduce?

    UPS Folder Problem : UPS Folder Size or size is Increasing too frequently or not getting larger directory.UPS Folder size is not getting increased. If you use Net application and listen to the folder using netstat command and see that the folder has this problems.Not allowing the process’s to run.If you run the netstat command and you see like this ‘Cannot process network requests. If this was caused by http://www.bevispo.eu/wp-content/uploads/2022/06/yoshinoGRAPH.pdf
    50e0806aeb jamvada

    Reply
  8. bit.ly
    bit.ly says:

    Pretty great post. I simply stumbled upon your blog and wished to say that
    I have really loved browsing your weblog posts. In any case I’ll
    be subscribing to your rss feed and I hope you write again very soon!

    Reply
  33. zorivareworilon
    zorivareworilon says:

    An impressive share, I just given this onto a colleague who was doing a little analysis on this. And he in fact bought me breakfast because I found it for him.. smile. So let me reword that: Thnx for the treat! But yeah Thnkx for spending the time to discuss this, I feel strongly about it and love reading more on this topic. If possible, as you become expertise, would you mind updating your blog with more details? It is highly helpful for me. Big thumb up for this blog post!

    Reply
  62. tinyurl.com
    tinyurl.com says:

    I’m really enjoying the design and layout of your website.

    It’s a very easy on the eyes which makes it much more enjoyable for me to come here and visit more often. Did you hire
    out a designer to create your theme? Outstanding work!

    Reply
  117. t.co
    t.co says:

    Excellent post. Keep posting such kind of info on your page.

    Im really impressed by your blog.
    Hey there, You’ve done a fantastic job. I will definitely digg it and
    personally recommend to my friends. I’m confident
    they will be benefited from this web site.

    Reply
  118. tinyurl.com
    tinyurl.com says:

    Oh my goodness! Incredible article dude! Thank you, However I
    am having difficulties with your RSS. I don’t understand why I am unable to join it.
    Is there anyone else getting similar RSS issues? Anyone that knows the solution can you kindly respond?

    Thanx!!

    Reply
  128. tinyurl.com
    tinyurl.com says:

    Wonderful items from you, man. I’ve understand your stuff prior
    to and you are simply extremely magnificent.
    I really like what you’ve got here, really like what you’re stating
    and the way in which you assert it. You are making it enjoyable and you continue to take care of to keep it smart.

    I can’t wait to read far more from you. This is really a great site.

    Reply
  136. tinyurl.com
    tinyurl.com says:

    Thank you a bunch for sharing this with all of us you
    actually recognise what you are speaking approximately!
    Bookmarked. Please additionally seek advice from my
    site =). We could have a link exchange contract among us

    Reply
  148. http://tinyurl.com/28z4j67w
    http://tinyurl.com/28z4j67w says:

    An outstanding share! I’ve just forwarded this onto a
    coworker who was doing a little research on this. And
    he in fact bought me breakfast because I found it for him…
    lol. So allow me to reword this…. Thank YOU for the meal!!

    But yeah, thanks for spending some time to talk about this issue
    here on your blog.

    Reply
  153. tinyurl.com
    tinyurl.com says:

    My brother suggested I would possibly like this blog.
    He used to be totally right. This submit actually made my day.
    You can not imagine just how a lot time I had spent for this info!
    Thanks!

    Reply
  187. online doctor
    online doctor says:

    Hey there I am so excited I found your site, I really
    found you by error, while I was researching on Digg for something else, Regardless I am here
    now and would just like to say thanks a lot for a fantastic post and a all
    round enjoyable blog (I also love the theme/design), I don’t
    have time to go through it all at the moment but I have book-marked it
    and also added your RSS feeds, so when I have time I will be back to read much more,
    Please do keep up the superb work.

    Reply
  188. korbiwiki.de
    korbiwiki.de says:

    The other day, while I was at work, my cousin stole my apple ipad and tested to see if
    it can survive a 40 foot drop, just so she can be a youtube sensation. My apple
    ipad is now destroyed and she has 83 views. I know this is entirely off topic but I had to share it with
    someone!

    Reply
  191. tinyurl.com
    tinyurl.com says:

    I’ve been exploring for a little for any high-quality articles or blog posts in this kind of space .
    Exploring in Yahoo I eventually stumbled upon this web site.
    Reading this information So i am happy to exhibit that I’ve an incredibly just
    right uncanny feeling I came upon exactly what I needed.

    I so much undoubtedly will make sure to do not fail to remember this site and give it a look
    regularly.

    Reply
  205. special
    special says:

    Thanks for every other informative web site.

    The place else may just I am getting that type
    of information written in such a perfect manner?
    I’ve a undertaking that I’m simply now working on, and I’ve been at the glance out for such information.

    Feel free to surf to my web page :: special

    Reply
  208. tinyurl.com
    tinyurl.com says:

    I’m not sure exactly why but this website is loading extremely slow for me.
    Is anyone else having this problem or is it a problem on my end?
    I’ll check back later and see if the problem still exists.

    Reply
  222. vivoslot
    vivoslot says:

    Hmm is anyone else having problems with the pictures on this blog loading?
    I’m trying to determine if its a problem on my end or if it’s
    the blog. Any responses would be greatly appreciated.

    Reply
  224. skrap-buking.ru
    skrap-buking.ru says:

    What you said made a ton of sense. But, what about this?
    what if you typed a catchier post title? I
    mean, I don’t want to tell you how to run your website, however suppose you added something that
    makes people want more? I mean Increasing Neck Pain, Low Libido, Weight
    Gain – Maybe Your Opioid Medication Is to Blame? – Pain Neck is kinda vanilla.

    You could glance at Yahoo’s front page and see how
    they write news titles to grab people to click. You might try adding a video or a picture or two to
    get people excited about everything’ve got to say. Just my opinion, it could make your website a little bit more interesting.

    vapor item suppliers

    Feel free to surf to my blog :: disposable vape white label, skrap-buking.ru,

    Reply
  229. 파라오카지노 본사
    파라오카지노 본사 says:

    Hello! I know this is kind of off topic but I was wondering which
    blog platform are you using for this website?
    I’m getting tired of WordPress because I’ve had problems with hackers
    and I’m looking at alternatives for another platform.
    I would be awesome if you could point me in the direction of a good platform.

    Reply
  262. whatsapp last seen checker
    whatsapp last seen checker says:

    Hi just wanted to give you a brief heads up and let
    you know a few of the images aren’t loading correctly. I’m not sure why but I think its a linking issue.
    I’ve tried it in two different internet browsers and both
    show the same outcome.

    Reply
  263. USA Script Helpers
    USA Script Helpers says:

    Greetings from Los angeles! I’m bored to tears at work so I decided
    to browse your website on my iphone during lunch break.

    I enjoy the knowledge you provide here and can’t wait to
    take a look when I get home. I’m amazed at how fast your blog loaded on my mobile ..

    I’m not even using WIFI, just 3G .. Anyways, amazing blog!

    Reply
  265. special
    special says:

    Hi there, just became alert to your blog through Google, and found that it is really informative.

    I am going to watch out for brussels. I’ll appreciate if you continue this in future.
    Many people will be benefited from your writing.
    Cheers!

    my website; special

    Reply
  267. special
    special says:

    I am really enjoying the theme/design of your weblog.
    Do you ever run into any internet browser compatibility problems?
    A small number of my blog visitors have complained about my website not working correctly in Explorer but looks great in Firefox.
    Do you have any suggestions to help fix this problem?

    Also visit my site :: special

    Reply
  270. tinyurl.com
    tinyurl.com says:

    My brother recommended I might like this web site. He was totally
    right. This post actually made my day. You can not imagine simply
    how much time I had spent for this information! Thanks!

    Reply
  296. dick transex
    dick transex says:

    Hello there! Do you know if they make any plugins to
    help with SEO? I’m trying to get my blog to rank
    for some targeted keywords but I’m not seeing very
    good gains. If you know of any please share.
    Kudos!

    Reply
  298. WayneSef
    WayneSef says:

    Когда вы боретесь с расстройством, связанным с употреблением алкоголя, вам может казаться, что конца не видно, но вы не должны страдать в одиночестве. Сегодня существует множество вариантов лечения, которые помогут вам излечиться от алкоголизма и вернуться к здоровой и полноценной жизни.
    Различные факторы, такие как история болезни, система поддержки и личная мотивация, могут сыграть свою роль в успехе вашего выздоровления. Лечение должно проходить под наблюдением группы медицинских специалистов в реабилитационном центре. По всей стране в центрах лечения алкоголизма работают профессионалы, которые проведут вас через все этапы процесса выздоровления – от детоксикации до жизни после реабилитации. Считайте их своей круглосуточной системой поддержки, которая будет радоваться вашим успехам и вместе с вами преодолевать любые трудности.
    Помните, что преодоление алкоголизма – это процесс. Менее половины людей рецидивируют после достижения одного года трезвости. Это число уменьшается до менее 15% после пяти лет трезвости. Чтобы получить наибольшие шансы на долгосрочную трезвость после завершения стационарной или амбулаторной программы, вам следует участвовать в местных группах поддержки и продолжать консультации. Лечение алкоголизма – это инвестиция в ваше будущее. Оно изменит к лучшему не только вашу жизнь, но и жизнь окружающих вас людей, таких как члены семьи и друзья.

    http://www.saronit.ru/lechenie-alkogolizma-v-moskve/

    Reply
  300. blog
    blog says:

    It’s a shame you don’t have a donate button! I’d certainly donate to this brilliant blog!
    I suppose for now i’ll settle for book-marking and adding your
    RSS feed to my Google account. I look forward to brand new updates
    and will talk about this blog with my Facebook group.
    Talk soon!

    Reply
  311. kebun777
    kebun777 says:

    Hello There. I discovered your weblog using msn. That is a very neatly written article.
    I’ll make sure to bookmark it and come back to read extra of your useful info.
    Thank you for the post. I’ll certainly comeback.

    Reply
  322. HaroldRab
    HaroldRab says:

    Что такое гибкие кабели?
    Самый простой кабель – это одножильный провод с пластиковой оболочкой.
    Он может гнуться и сохраняет этот изгиб – если вы не делаете это слишком часто, потому что иначе провод ломается.
    Такие простые кабели используются в домашних установках.
    После установки кабель остается нетронутым в течение десятилетий.
    Такие твердые провода не подходят для многих других применений, где кабели должны быть гибкими и эластичными.
    Здесь проводники в жилах состоят из нитей – пучков тонких проволок, которые можно сгибать миллионы раз, в зависимости от конструкции, не ломая и не теряя свойств тока или передачи данных.
    Одно из самых неприятных мест для кабеля – тяговая цепь. Здесь кабели питания, сервопривода и передачи данных расположены близко друг к другу и перемещаются вперед-назад по мере работы машины.
    Иногда со скоростью более пяти метров в секунду с ускорением, превышающим ускорение силы тяжести более чем в пять раз.
    Кабели проложены в тяговой цепи таким образом, что они изгибаются только в одном направлении.
    КГ 1х120-0,66

    Reply
  334. สิวผด
    สิวผด says:

    Hi there! Someone in my Myspace group shared this website with us so I came to look it over. I’m definitely enjoying the information. I’m bookmarking and will be tweeting this to my followers! Superb blog and brilliant design.

    Reply
  343. kbc lottery number check online
    kbc lottery number check online says:

    Hello there, simply became alert to your blog thru Google, and found that it’s really informative. I’m gonna watch out for brussels. I will be grateful in the event you continue this in future. Many other people will likely be benefited from your writing. Cheers!

    Reply
  349. hemsida om brostforstoring
    hemsida om brostforstoring says:

    Do you mind if I quote a few of your posts as long as I provide credit and sources back to your site? My blog is in the exact same area of interest as yours and my visitors would really benefit from a lot of the information you provide here. Please let me know if this okay with you. Appreciate it!

    Reply
  351. Kampus Islam Terbaik 2022
    Kampus Islam Terbaik 2022 says:

    The subsequent time I learn a blog, I hope that it doesnt disappoint me as much as this one. I imply, I do know it was my choice to learn, however I truly thought youd have one thing fascinating to say. All I hear is a bunch of whining about one thing that you can repair for those who werent too busy on the lookout for attention.

    Reply
  353. togel online
    togel online says:

    Pretty component to content. I simply stumbled upon your website and in accession capital to claim that I get in fact loved account your blog posts. Any way I’ll be subscribing for your feeds or even I achievement you get entry to constantly quickly.

    Reply
  355. NDIS Investments
    NDIS Investments says:

    I’ve been surfing on-line greater than three hours lately, yet I never found any interesting article like yours. It is pretty value sufficient for me. In my opinion, if all site owners and bloggers made excellent content material as you probably did, the net can be a lot more useful than ever before.

    Reply
  357. daftar mpo4d
    daftar mpo4d says:

    Hey I know this is off topic but I was wondering if you knew
    of any widgets I could add to my blog that automatically tweet my newest twitter updates.
    I’ve been looking for a plug-in like this for quite some time and was hoping maybe you would have some experience with something like this.

    Please let me know if you run into anything. I truly enjoy reading your blog and I look forward to your new updates.

    Reply
  361. סוכן 7xl
    סוכן 7xl says:

    I and my pals happened to be digesting the nice helpful tips from your web blog while then got a terrible suspicion I never expressed respect to the website owner for those techniques. Most of the people were for this reason thrilled to see them and now have simply been making the most of these things. Appreciate your turning out to be simply considerate as well as for settling on such good issues most people are really needing to be informed on. Our honest regret for not saying thanks to sooner.

    Reply
  367. slot online
    slot online says:

    Have you ever thought about including a little bit more than just your articles? I mean, what you say is fundamental and all. But think of if you added some great graphics or video clips to give your posts more, “pop”! Your content is excellent but with images and clips, this website could certainly be one of the most beneficial in its niche. Fantastic blog!

    Reply
  368. poker online
    poker online says:

    I have been exploring for a little bit for any high-quality articles or weblog posts in this kind of area . Exploring in Yahoo I finally stumbled upon this web site. Reading this info So i¦m satisfied to convey that I’ve an incredibly just right uncanny feeling I discovered exactly what I needed. I such a lot undoubtedly will make certain to don¦t overlook this web site and give it a look regularly.

    Reply
  374. rana pratap singh kbc phone number
    rana pratap singh kbc phone number says:

    Hi, I think your site might be having browser compatibility issues. When I look at your website in Safari, it looks fine but when opening in Internet Explorer, it has some overlapping. I just wanted to give you a quick heads up! Other then that, fantastic blog!

    Reply
  380. hotel
    hotel says:

    I’ve been surfing on-line more than 3 hours as of late, but I by no means found any attention-grabbing article like yours. It?¦s beautiful worth sufficient for me. Personally, if all webmasters and bloggers made just right content material as you did, the web might be much more helpful than ever before.

    Reply
  384. joker slot thai
    joker slot thai says:

    ยินดีสล็อตได้ที่สล็อต888สุขบาคาร่า888เดิมพันสล็อต เว็บตรงเกมส์
    สล็อตวัดดวงคาสิโนปอยเปตเทรดสล็อต เว็บ ตรง ไม่ ผ่าน
    เอเย่นต์ ไม่มี ขั้น
    ต่ำแทงสูตร บาคาร่าเดิมพันบาคาร่า 168วัดดวงสล็อต pg เว็บตรงเดิมพันออนไลน์สล็อตpg ทดลองเล่นเทรดสล็อต xo เว็บตรงจัดเว็บ คาสิโนเทรดเว็บ
    ตรง สล็อตpgเล่นบาคาร่า6699จัดยู ฟ่า สล็อต เว็บตรงแทงคาสิโน autoเทรดสล็อต ฝากถอน ไม่มีขั้นต่ำจัดสล็อต สัตว์แทงสุดเทพสล็อต เติม true wallet
    ฝาก ถอน ไม่มี ขั้นต่ำ 2021วัดดวงเครดิตฟรี
    ซุปเปอร์ สล็อตเล่นblm สล็อต

    Here is my site … joker slot thai

    Reply
  385. how to make money online easily
    how to make money online easily says:

    Hey very nice web site!! Man .. Excellent .. Amazing .. I’ll bookmark your blog and take the feeds also…I’m happy to find so many useful information here in the post, we need work out more techniques in this regard, thanks for sharing. . . . . .

    Reply
  390. Fungame777
    Fungame777 says:

    Hi there! Do you know if they make any plugins to assist with Search Engine Optimization? I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good success. If you know of any please share. Thank you!

    Reply
  393. slot hoki
    slot hoki says:

    Great post. I was checking continuously this blog and I am impressed! Extremely useful info particularly the last part 🙂 I care for such information a lot. I was seeking this certain information for a very long time. Thank you and best of luck.

    Reply
  408. maa ki kahani
    maa ki kahani says:

    I do love the way you have framed this particular situation and it does indeed offer me personally a lot of fodder for thought. However, coming from everything that I have observed, I just simply hope as other responses pile on that men and women keep on point and not embark on a tirade associated with the news of the day. Anyway, thank you for this outstanding point and whilst I do not really go along with the idea in totality, I value your standpoint.

    Reply
  413. pilates
    pilates says:

    Terrific work! That is the kind of info that are supposed to be shared around the web. Shame on the search engines for no longer positioning this submit upper! Come on over and consult with my web site . Thank you =)

    Reply
  416. San Diego Hills kristen
    San Diego Hills kristen says:

    Howdy this is somewhat of off topic but I was wanting to know if blogs use WYSIWYG editors or if you have to manually code with HTML. I’m starting a blog soon but have no coding skills so I wanted to get guidance from someone with experience. Any help would be greatly appreciated!

    Reply
  417. dg
    dg says:

    เล่นคาสิโนมันร่วมกับสล็อตเว็บตรงสะใจบาคาร่า666เทรดสล็อต เว็บ ตรงเกม สล็อตเดิมพันคาสิโนออนไลน์1688เทรดสล็อต ทดลองเล่นแทงสล็อต เครดิต ฟรีเล่นสล็อต 168เล่นทดลองเล่น
    บาคาร่าวัดใจบาคาร่า77เล่นทดลองเล่น สล็อตppเล่นทดลอง สล็อตแทงสล็อต
    xo ฝากถอนไม่มีขั้นต่ําวัดสล็อต
    โอน ผ่าน วอ เลท ไม่มี ขั้น ต่ํา 2021วัดบาคาร่า saclub7แทงสล็อต เครดิต ฟรี ล่าสุดเดิมพันสล็อต 008เทรดสล็อต วอ เลท
    ไม่มีขั้นต่ําจัดสนุกสล็อต1234ฝาก10รับ100วัดดวงสล็อต168เครดิตฟรีวัดดวงสล็อต แตกดี

    Reply
  447. superhile apk
    superhile apk says:

    The heart of your writing while sounding reasonable in the beginning, did not really work well with me personally after some time. Somewhere throughout the paragraphs you were able to make me a believer unfortunately just for a very short while. I still have a problem with your leaps in assumptions and one would do well to fill in all those gaps. If you can accomplish that, I will undoubtedly end up being fascinated.

    Reply
  451. A Orfã 2 A Origem Online
    A Orfã 2 A Origem Online says:

    Somebody essentially lend a hand to make critically posts I’d state. This is the first time I frequented your website page and thus far? I amazed with the analysis you made to create this particular publish incredible. Fantastic job!

    Reply
  453. gmailbet
    gmailbet says:

    You really make it appear really easy along with your presentation but I find this topic to be actually one thing that I feel I might by no means understand. It kind of feels too complicated and extremely extensive for me. I’m looking forward to your next post, I will try to get the dangle of it!

    Reply
  461. slot hoki
    slot hoki says:

    Thank you for the sensible critique. Me and my neighbor were just preparing to do a little research about this. We got a grab a book from our local library but I think I learned more clear from this post. I am very glad to see such excellent info being shared freely out there.

    Reply
  469. travel electronics
    travel electronics says:

    I wanted to compose you the little observation to finally say thank you once again with your wonderful basics you have shown in this case. It is quite extremely open-handed with you to provide publicly what a few individuals could have supplied for an ebook to generate some money for themselves, specifically considering that you could have done it in case you decided. The concepts as well worked like a fantastic way to be certain that most people have similar desire just as my own to understand a great deal more with regard to this condition. I am certain there are many more enjoyable situations up front for individuals who read through your site.

    Reply
  473. iq option login
    iq option login says:

    obviously like your web-site but you need to check the spelling on quite a few of your posts. Many of them are rife with spelling problems and I find it very troublesome to tell the truth nevertheless I’ll definitely come back again.

    Reply