Definitions and Terms Arachnoiditis: A non-specific inflammatory reaction of the
arachnoidea mater of mulitfactorial etiology. Recognized risk
factors include but not limited to; spinal surgery, a variety of
myelographic agents, viral and bacterial meningitis, tuberculosis,
syphilis, intrathecal hemorrhage, spinal injections of steroids, and
anesthetic agents. The inflammatory process causes fibrosis and
hyalinization of the arachnoid membrane, which becomes thickened and
adherent to both the pia and dura mater around the spinal cord and the
cauda equina. Changes range from clumping of nerve roots and
blunting of nerve root sleeves to multisegmental transverse obliteration
of the subarachnoid space. (Aldrete) Arachnoiditis
describes a pain disorder caused by the inflammation of the arachnoid,
one of the membranes that surround and protect the nerves of the spinal
cord. The arachnoid can become inflamed because of an irritation
from chemicals, infection from bacteria or viruses, as the result of
direct injury to the spine, chronic compression of spinal nerves, or
complications from spinal surgery or other invasive spinal procedures.
Inflammation can sometimes lead to the formation of scar tissue and
adhesions, which cause the spinal nerves to “stick” together. If arachnoiditis
begins to interfere with the function of one or more of these nerves, it
can cause a number of symptoms, including numbness, tingling, and a
characteristic stinging and burning pain in the lower back or legs.
Some people with arachnoiditis will have debilitating
muscle cramps, twitches, or spasms. It may also affect bladder,
bowel, and sexual function. In severe cases, arachnoiditis
may cause paralysis of the lower limbs. Is there any treatment?
Arachnoiditis remains a difficult condition to treat, and
long-term outcomes are unpredictable. Most treatments for arachnoiditis
are focused on pain relief and the improvement of symptoms that impair
daily function. A regimen of pain management, physiotheraphy,
exercise, and psychotheraphy is often recommended. Surgical
intervention is controversial since the outcomes are generally poor and
provide only short-term relief.
What is the prognosis? Arachnoiditis appears to
be a disorder that causes chronic pain and neurological deficits and
does not improve significantly with treatment. Surgery may only
provide temporary relief, and may worsen the condition. Aging and
pre-existing spinal disorders can make an accurate prognosis
problematic. The outlook for someone with arachnoiditis
is complicated by the fact that the disorder has no predictable pattern
or severity of symptoms. What research is being done? Within
the NINDS research programs, arachnoiditis is addressed
primarily through studies associated with pain research. NINDS
vigorously pursues a research program seeking new treatments for pain
and nerve damage with the ultimate goal of reversing debilitating
conditions such as arachnoiditis. (RightHealth) Abstinence
syndrome – A syndrome that
may occur with abrupt cessation or diminution of chronic drug
administration; the nature and time of onset of this syndrome vary with
drug actions and half-life. Activation
– Excitation of a neuron
sufficient to generate a nerve impulse (action potential). Acoustic: Having to do with sound or hearing. (NIH) Acupuncture
– A traditional Chinese medical practice of insertion and manipulation
of fine needles into specific exterior body locations (acupuncture
points) to relieve pain, to induce surgical anesthesia, and for
therapeutic purposes. This process is believed to adjust and alter the
body's energy flow into healthier patterns, and is used to treat a wide
variety of illnesses and health conditions This alternative is often
included in pain management programs (NIPC 2005). Acute
pain – Warning pain, the
discomfort or signal that alerts of something physically wrong in the
body. Pain may result from any condition that stimulates the body's
sensors, such as inflammation, infections, injuries, hemorrhages,
tumors, and metabolic or endocrine problems. Acute pain usually abates
as the underlying problem is treated. Early management of acute pain may
hasten the recovery of the causative problem and reduce the length of
treatment. Addiction
– A primary, chronic,
neurobiological disease, with genetic, psychosocial, and environmental
factors influencing its development and manifestations. It is
characterized by behaviors that include one or more of the following:
impaired control over drug use, compulsive use, continued use despite
harm, and craving. Sometimes called "dependence," addiction
should not be confused with physiologic dependence -- eg, tolerance,
withdrawal -- that may naturally occur with opioid analgesics. Adenoma:
A benign epithelial tumor with a glandular organization. (NIH) Adhesions:
Pathological processes consisting of the union of the opposing surfaces
of a wound. (NIH) Adjuvant:
A substance which aids another, such as an auxiliary remedy; in
immunology, nonspecific stimulator of the immune response. (NIH) Adjuvant
analgesic –
A medication that is not primarily and analgesic but that has
independent or additive pain relieving effects. Agonists
– Agents that exert
pharmacologic effects by binding to and activating specific receptors. Alkaloid: A member of a large group of chemicals that are made by
plants and have nitrogen in them. Some
alkaloids have been shown to work against cancer. (NIH) Alopecia:
Absence of hair from areas where it is normally present. (NIH) Algogenic
– Pain-inducing. (Not
to be confused with Allogenic, meaning from individuals of the same
species. Tissue transplanted from one person to another is said to be
allogenic.) Allodynia
– Pain caused by a stimulus
that normally does not provoke pain, such as the light touch of a finger
or feather.. Alternative medicine: Practices not generally recognized by the
medical community as standard or conventional medical approaches and
used instead of standard treatments. Alternative medicine includes
the taking of dietary supplements, megadose vitamins, and herbal
preparations, the drinking of special teas; and practices such as
massage therapy, magnet therapy, spiritual healing, and meditation.
(NIH) Anaesthesia:
Loss of feeling or sensation. Although
the term is used for loss of tactile sensibility, or of any of the other
senses, it is applied especially to loss of the sensation of pain, as it
is induced to permit performance of surgery or other painful procedures.
(EU) Analgesic:
An agent that alleviates pain without causing loss of consciousness. (EU) Analgesia
– Absence of pain in
response to a normally painful stimulus, typically without loss of
consciousness (NPEC 2006). Analgesic
ceiling – A dose of an
analgesic beyond which no additional analgesia is obtained. Anesthesia
– Generally, a loss of sensation resulting from pharmacologic
depression of nerve function or from neurological dysfunction
(Stedman’s 2000). Anesthesia:
A state characterized by loss of feeling or sensation.
This depression of nerve function is usually the result of
pharmacologic action and is induced to allow performance of surgery or
other painful procedures. (NIH) Aneurysm:
A sac formed by the dilatation of the wall of an artery, a vein, or the
heart. (NIH) Ankylosing
spondylitis – Ankylosing
(fusing together) spondylitis (spinal inflammation) is a type of
arthritis that affects the spine. Antagonists
– Agents that competitively
bind with the binding sites of agonists and thereby inhibit the agonist
actions. Antibacterial: A substance that destroys bacteria or suppresses
their growth or reproduction. (NIH) Antidepressant
– An agent that stimulates
the mood, generally relieving symptoms of depressive disorders (unipolar
or bipolar) by increasing levels of excitatory neurotransmitters. The
main types of antidepressant drugs in use are: tricyclic, selective
serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors
(MAOIs). Antidepressant agents typically have a slow onset of action
taking 3 to 5 weeks. Although adverse effects may be seen as early as
the first dose, significant therapeutic improvement is delayed.
Similarly, the effects of antidepressants will continue for a similar
length of time after the drugs have been discontinued (NIPC 2006,
Uretsky 2002). Antiemetics
– Agents that prevent or
alleviate nausea and vomiting. They are typically used to treat motion
sickness and the side effects of opioid analgesics and chemotherapy (NIPC
2006). Antiepileptic
Drug (AED) – An agent that
combats epilepsy and also may be used in the treatment of chronic pain.
AEDs may alter pain transmission by interacting with specific
neurotransmitters and ion channels. The agents differ in neuropathic and
non-neuropathic pain, and agents within each medication class have
varying degrees of efficacy (NIPC 2006, Maizels and McCarberg 2005). Arterial: Pertaining to an artery or to the arteries. (NIH) Artery:
Vessel-carrying blood from the heart to various parts of the body. (NIH) Arthritis
– A general term for a
group of more than 100 diseases, typically involving inflammation and
swelling of a joint, or a state characterized by joint inflammation.
There are many forms of arthritis, each of which has a different cause:
rheumatoid arthritis and psoriatic arthritis are autoimmune diseases in
which the body is attacking itself; septic arthritis is caused by joint
infection; gouty arthritis is caused by deposition of uric acid crystals
in the joint and subsequent inflammation; and the most common form of
arthritis, osteoarthritis is also known as degenerative joint disease
and occurs following trauma to the joint, following an infection of the
joint, or simply as a result of aging (NIPC 2006, Cleveland Clinic
2005). Arthropathy; Any joint disease. (NIH) Aseptic:
Free from infection or septic material; sterile. (NIH) Asymptomatic:
Having no signs or symptoms of disease. (NIH) Ataxia:
Impairment of the ability to perform smoothly coordinated voluntary
movements. This condition
may affect the limbs, trunk, eyes, pharynx, larynx, and other
structures. Ataxia may
result from impaired sensory or motor function.
Sensory ataxia may result from posterior column injury or
peripheral nerve diseases. Motor
ataxia may be associated with cerebellar diseases; cerebral cortex
diseases; thalamic diseases; basal ganglia diseases; injury to the red
nucleus; and other conditions. (NIH) Atrophy:
Decrease in the size of a cell, tissue, organ, or multiple organs,
associated with a variety of pathological conditions such as abnormal
cellular changes, ischemia, malnutrition, or hormonal changes. (NIH) Autoimmune
disease: A condition in which the body recognizes it own tissues as
foreign or hormonal changes. (NIH) Behavioral
therapy or behavioral modification
– Therapy that is concerned with the treatment or
modification of observable behaviors rather than underlying
psychological processes. Behavioral therapy applies learning principles
to substitute desirable responses and behavior patterns for undesirable
ones (for example, phobias or obsessions) (NIPC 2006). Benign: Not cancerous; does not invade nearby tissue or spread to
other parts of the body. (NIH) Beta-blockers
– A class of drugs that
combine with and block the activity of the beta-receptor to decrease the
heart rate and force of contractions and lower blood pressure.
Beta-blockers are used to treat hypertension, angina pectoris, and
ventricular and supraventricular arrhythmias by controlling certain
hormones (catecholamines) released by the body as part of its response
to heart failure. Beta-blockers are also used to prevent migraines,
treat tremors, and control anxiety (NIPC 2006). Bewilderment:
Impairment or loss of will power. (NIH) Bioavailability
– The rate and extent to
which an active drug or metabolite enters the general circulation,
thereby permitting access to the site of action. Biofeedback
– The process of training a
person (or animal) to regulate physiologic responses by providing
feedback (typically sounds or light patterns) about those responses.
Clinically, patients are typically taught to control finger temperature,
perspiration, muscle tension, and other responses. Biopsychosocial
– Relating to the
biological, psychological, and social aspects in contrast to the
strictly biomedical aspects of disease or chronic pain. This is a way of
looking at the mind and body of a patient as two important, interlinked
systems (the mind-body connection) (NIPC 2006, Krames 2001). Bladder:
The organ that stores urine. (NIH) Blood pressure:
The pressure of blood against the walls of a blood vessel or heart
chamber. Unless there is a
reference to another location, such as the pulmonary artery or one of
the heart chambers, it refers to the pressure in the systemic arteries,
as measured, for example, in the forearm. (NIH) Blood vessel:
A tube in the body through which blood circulates.
Blood vessels include a network of arteries, arterioles,
capillaries, venules, and veins. (NIH) Body Fluids:
Liquid components of living organisms. (NIH) Botulinum
toxin type A (Botox) – A
purified botulinum toxic, used by injection to relax muscles. It is
often used to treat certain eye conditions, severe sweating of the
armpits, in cosmetic dermatology and plastic surgery to minimize
wrinkles, and in pain management to treat migraines (NIPC 2006,
MedlinePlus 2006). Breakthrough
pain – Pain that overwhelms
or “breaks through” any pain relief afforded by ongoing analgesics. Buprenorphine
– A semi-synthetic opioid
agonist-antagonist used as an analgesic for moderate to severe pain and
as an anesthesia adjunct. It can be administered sublingually or by
intramuscular or intravenous injection, and is increasingly used
(sublingually) rather than oral methadone for treating opioid abuse (NIPC
2006, WebMD 2006). Calcifications: Deposits of calcium in the tissues of the breast.
Calcification in the breast can be seen on a mammogram, but
cannot be detected by touch. There
are two types of breast calcification, macrocalcification and
microcalcification. Macrocalcifications
are large deposits and are usually not related to cancer.
Microcalcifications are specks of calcium that may be found in an
area of rapidly dividing cells. Many
microcalcifications clustered together may be a sign of cancer. (NIH) Calcium:
A basic element found in nearly all organized tissues.
It is a member of the alkaline earth family of metals with the
atomic symbol Ca. Calcium is
the most abundant mineral in the body and combines with phosphorus to
form calcium phosphate in the bones and teeth.
It is essential for the normal functioning of nerves and muscles
and plays a role in blood coagulation and in many enzymatic processes. (NIH) CAM
-- Complementary and Alternative Medicine -- a group of diverse medical
and healthcare systems, practices, and products that are not presently
considered to be part of conventional medicine as practiced in the Capsaicin
– A component of certain
plants (cayenne, red pepper), used topically to relieve minor arthritis
and neuralgia pain. Capsaicin, when applied to the skin, causes a
burning sensation; it is believed that this burning depletes the nerve
cells of a chemical (substance P), which has a role in transmitting pain
messages (NIPC 2006; MedlinePlus 2006). Carcinogenic: Producing carcinoma. (EU) Cardiac:
Having to do with the heart. (NIH) Case report:
A detailed report of the diagnosis, treatment, and follow-up of an
individual patient. Case
reports also contain some demographic information about the patient (for
example, age, gender, ethnic origin). (NIH) Catheter:
A flexible tube used to deliver fluids into or withdraw fluids from the
body. (NIH) Cauda Equina:
The lower part of the spinal cord consisting of the lumbar, sacral, and
coccygeal nerve roots. (NIH) Caudal:
Denoting a position more toward the cauda, or tail, than some specified
point of reference; same as inferior, in human anatomy. (NIH) Cauda equina syndrome -- Impairment of the nerves in the cauda equina, the bundle of spinal nerve roots that arise from the lower end of the spinal cord. The syndrome is characterized by dull pain in the lower back and upper buttocks and lack of feeling (anesthesia) in the buttocks, genitalia, and thigh, together with disturbances of bowel and bladder function. Causalgia
– A burning pain and
sensitivity to vibration or touch, usually in the hand or foot, at a
site removed from an injury of a peripheral nerve that has healed (NIPC
2006; NPEC 2006; Mersky and Bogduk 1994). Cell:
The individual unit that makes up all of the tissues of the body.
All living things are made up of one or more cells. (NIH) Celiac
plexus – A network of nerve
fibers in the abdomen that conducts pain sensation from the abdominal
organs, including the liver, spleen, stomach, and pancreas (MayoClinic.com
2005). Central
pain – Pain associated,
initiated, or caused by a lesion in the central nervous system (NPEC
2006; Mersky and Bogduk 1994). Central
sensitization – Enhanced
excitability and responsiveness of spinal neurons producing long-lasting
changes. Central
nervous system (CNS) –
Consists of the brain and spinal cord. Central Nervous System: (CNS) The main information-processing organs
of the nervous system, consisting of the brain, spinal cord, and
meninges. (NIH) Central Nervous System Infections:
Pathogenic infections of the brain, spinal cord, and meninges.
DNA virus infections; RNA virus infections; bacterial infections;
mycoplasma infections; Spirochaetales infections; fungal infections;
protozoan infections; helminthiasis; and prion diseases may involve the
central nervous system as a primary or secondary process. (NIH) Cerebral:
Of or pertaining to the cerebrum or the brain. (NIH) Cerebral
cortex – Gray cellular
“mantle” of the brain, which includes the sensory cortex, motor
cortex, and association cortex. Cerebrospinal: Pertaining to the brain and spinal cord. (EU) Cerebrospinal Fluid:
CSF. The fluid flowing
around the brain and spinal cord. Cerebrospinal
fluid is produced in the ventricles in the brain. (NIH) Cerebrum;
The largest part of the brain. It
is divided into two hemispheres, or halves called the cerebral
hemispheres. The cerebrum
controls muscle functions of the body and also controls speech,
emotions, reading, writing, and learning. (NIH) Cervical:
Relating to the neck, or to the neck of any organ or structure.
Cervical lymph nodes are located in the neck; cervical cancer
refers to cancer of the uterine cervix, which is the lower, narrow end
(the neck) of the uterus. (NIH) Chronic:
A disease or condition that persists or progresses over a long period of
time. (NIH) Chronic
noncancer pain (CNCP) –
Persistent pain that is not associated with cancer. Chronic
nonmalignant pain (CNMP) –
Persistent pain that is not attributable to a life-threatening
condition; some prefer to use alternate terms, such as: chronic
noncancer pain, chronic non-cancer–related pain. Chronic pain – A long-term pain state that is persistent (usually defined as 3 months or longer) and in which identifying, treating, and/or removing the underlying cause poses a clinical challenge. Chronic pain sometimes may be associated with a long-term incurable or intractable medical condition or disease. \ Chronic
pain syndrome (CPS) –
Psychosocial disorder that occurs in some patients with chronic
noncancer pain in which symptoms of the pain consume the attention of
the patients and becomes incapacitating. Computerized tomography: CT scan.
A series of detailed pictures of areas inside the body, taken
from different angles; the pictures are created by a computer linked to
an x-ray machine. Also
called computerized tomography and computerized axial tomography. CAT
scan. (NIH) Connective Tissue:
Tissue that supports and binds other tissues.
It consists of connective tissue cells embedded in a large amount
of extracellular matrix. (NIH) Continuous
dysesthesia – A continuous
type of neuropathic pain that manifests as burning, electrical, or other
abnormal sensations. Contraindications: Any factor or sign that it is unwise to pursue a
certain kind of action or treatment. (NIH) Contrast Media:
Substances used in radiography that allow visualization of certain
tissues. (NIH) Coordination:
Muscular or motor regulation or the harmonious cooperation of muscles or
grouos of muscles, in a complex action or series of actions. (NIH) Corticosteroid:
Any of the steroids elaborated by the adrenal cortex in response to the
release of corticotrophin by the pituitary gland, to any of the
synthetic equivalents of these steroids, or to angiotensin II.
They are divided according to their predominant biological
activity, into three major groups; glucocorticoids, mineralocorticoids,
and C19 androgens. Some
corticosteroids exhibit both types of activity in varying degrees, and
others exert only one type of effect.
The corticosteroids are used clinically for hormonal replacement
therapy, for suppression of ACTH secretion by the anterior pituitary, as
antineoplastic, antiallergic, and anti-inflammatory agents, and to
suppress the immune response. (EU) Corticosteroid
–
Anti-inflammatory drug created from, or based on, a naturally occurring
hormone produced by the cortex of the adrenal glands (cortisone) (MayoClinic.com
2005). COX-2
inhibitor – A nonsteroidal
anti-inflammatory drug (NSAID) that specifically inhibits the enzyme
cyclooxygenase-2 (COX-2), which contributes to inflammation. COX-2
inhibitors are used to treat pain and are less likely to cause
gastrointestinal bleeding than other NSAIDs. Recent studies began to
uncover evidence that COX-2 inhibitors and other non-selective NSAIDs
may increase the risk of heart attack and stroke. Prompted by these
findings and other safety concerns, 2 of the 3 FDA-approved COX-2
inhibitors, brand names Vioxx® and Bextra®, were withdrawn from the
market (MayoClinic 2005, MedlinePlus 2006). CRPS
– Complex regional pain
syndrome, also known as reflex sympathetic dystrophy (RSD) and causalgia,
has been recognized for the past 2,500 years and believed in for the
past 150, but it has yet to be understood. These syndromes can be
characterized by discrete sensory, motor, and autonomic findings, but
many patients with CRPS continue to suffer for years without a
diagnosis. The role of the sympathetic nervous system in maintaining
these syndromes and its appropriateness as a target for treatment
continue to be subjects of controversy (Bennett and Brookoff 2006). Craniocerebral Trauma: Traumatic injuries involving the cranium and
intracranial structures (i.e., brain, cranial nerves; meninges; and
other structures). Injuries
may be classified by whether or not the skull is penetrated or whether
or there is an associated hemorrhage. (NIH) Cyclooxygenase
(COX) – Enzyme involved in
prostaglandin synthesis; there are two isoforms: COX-1 and COX-2. Deafferentation
– Temporary or permanent loss of primary afferent
fibers due to injury or disease. Deep
somatic pain – A type of
somatic pain associated with ongoing activation of nociceptors in
muscles, tendons, joint capsules, fasciae, or bones. Deep
tissues – Tissues including
bone, muscle, tendons, joint capsules, and fasciae. Dermatomes
– Cutaneous sensory
pathways that are defined by sensation; each dermatome corresponds to
the area of skin that is supplied by the dorsal roots of a particular
sensory nerve. Degenerative: Undergoing degeneration: tending to degenerate: having
the character of or involving degeneration.
(EU) Diaphoresis:
Perspiration, especially profuse perspiration. Also called sudoresis. (EU) Dorsal:
1. Pertaining to the back or to any dorsum.
2. Denoting a position more toward the back surface than some
other object of reference; same as posterior in human anatomy. (EU) Dorsal
horn (DH) – The posterior
gray matter of the spinal cord, which contains cell bodies (neurons).
The spinal cord consists of 10 laminae (segments) and laminae I-VI
comprise the dorsal horn. Dorsal
horn neurons – Neurons in
the dorsal horn of the spinal cord, including interneurons and second
order (projection) neurons. Dorsum: A plate of bone which forms the posterior boundary of the
sella turcica. (NIH) Duct:
A tube through which body fluids pass. (NIH) Dura mater:
The outermost, toughest, and most fibrous of the three membranes (meninges)
covering the brain and spinal cord; called also pachymeninx. (EU) Dysesthesia
– An unpleasant abnormal
sensation, which may be spontaneous or evoked, experienced by patients
with neuropathic pain; distinct from pain in the classical sense. Edema: Excessive amount of watery fluid accumulated in the
intercellular spaces, most commonly present in subcutaneous tissue. (NIH) Electrolyte:
A substance that dissociates into ions when fused or in solution, and
thus becomes capable of conducting electricity; an ionic solute. (EU) Endogenous
opioids – Natural opioid
compounds produced by the body; also referred to as enkephalins and
endorphins. Enkephalins
– Naturally occurring
molecules in the brain that attach to certain receptors in the brain and
spinal cord to stop pain messages. These receptors respond to morphine
and other opioid analgesics (MayoClinic.com 2005, MedlinePlus 2006). Enzyme: A protein that speeds up chemical reactions in the body. (NIH) Epidural:
The space between the wall of the spinal canal and the covering of the
spinal cord. An epidural
injection is given into this space. (NIH) Epidural
–
Situated on the outside of the dura mater (a tough lining that surrounds
the spinal cord; Equianalgesic
–
Having an equivalent analgesic effect. Equianalgesic
dose chart – A chart that
is used to convert from one analgesic or route of administration to
another. Such charts typically describe the dose of an opioid required
to produce the same degree of pain relief provided by a standard oral or
parenteral dose of morphine. Ergotamine
– An alkaloid derived from
ergot (fungus in the genus Claviceps), which narrows blood vessels
(vasoconstriction). They sometimes relieve pain by reducing pressure on
pain-sensitive structures that may be associated with cluster and/or
migraine headaches. It may also affect certain brain chemicals that
affect how a person feels pain (NIPC 2006, WebMD 2006). Excitatory
amino acids (EAAs) – These
include the neurotransmitters glutamate and aspartate, which mediate
most excitatory transmission in the central nervous system. Extracellular: Outside a cell or cells. (EU) Extravasation:
A discharge or escape, as of blood, from a vessel into the tissues. (EU) Facet joints – Joints found between two adjacent vertebrae at every spinal level, which are connected by an intervertebral disk in the front and two facet joints in the back. Facet joints provide about 20% of torsional stability in the neck and lower back (MayoClinic.com 2005). Fibromyalgia
– A syndrome described as
inflammation of the fibrous or connective tissue of the body. Symptoms
include diffuse musculoskeletal aching, chronic pain, stiffness, and
tenderness of muscles, tendons, and joints. Diagnosis is difficult and
frequently missed because symptoms of fibromyalgia are vague and
generalized. It does not cause body damage or deformity; however, undue
fatigue (and depression) plagues the large majority of patients, and
sleep disorders are common (NPEC 2006, NIPC 2006). Fibrosis: Any pathological condition where fibrous connective tissue
invades any organ, usually as a consequence of inflammation or other
injury. (NIH) Field
block injection – A
procedure used to relax a tender muscle, or to reduce muscle pain and
inflammation. The targeted muscle is injected with a local anesthetic
(for example, Lidocaine) and corticosteroid. Also called trigger point
injection (MayoClinic.com 2005). Fistula: Abnormal communication most commonly seen between two
internal organs, or between an internal organ and the surface of the
body. (NIH) Foramen:
A natural hole of perforation, especially one in a bone. (NIH) Fossa:
A cavity, depression, or pit. (NIH) Glucocorticoid:
A compound that belongs to the family of compounds called
corticosteroids. They affect
metabolism and have anti-inflammatory and immunosuppressive effects.
They may be naturally produced (hormones) or synthetic (drugs). (NIH) Glutamate
– An excitatory amino acid
neurotransmitter responsible for much of excitatory transmission in the
central nervous system. Grafting:
The operation of transfer of tissue from one site to another. (NIH) Headache
– A pain in the head above
the eyes or ears, behind the head (occipital), or on the back of the
upper neck. All headaches are grouped into primary headaches and
secondary headaches. Primary headaches are not associated with other
diseases and include migraine, tension, and cluster headaches. Secondary
headaches are caused by other diseases, which may be major or minor (NIPC
2006). Headache,
cluster – A headache
syndrome also called migrainous neuralgia. There are two main types of
cluster headache: episodic and chronic. Episodic is the most common
pattern, characterized by 1 to 3 short attacks of pain around the eyes
per day. The attacks are clustered over a stretch of 1 to 2 months
followed by an approximate remission of a year. Chronic cluster headache
is characterized by the absence of sustained periods of remission and
may start with no past history of cluster headaches or it may emerge
several years after an episodic pattern of cluster headaches (NIPC
2006). Headache,
medication overuse – Daily
use of simple analgesics, opioids, ergotamine, or barbiturate compounds
can cause worsening of headaches once the medication is discontinued (NIPC
2006). Headache,
rebound – This type of
headache is experienced by those who have taken analgesics or
ergotamines for migraines or other health issues, and who have built up
a tolerance. The headache frequently occurs immediately after the
medication wears off. Using the medication less frequently or switching
to a different medication may treat the headache. Some patients find
relief from acute ergotamine rebound with injected phenothiazine or
long-acting steroid medication (NIPC 2006). Headache,
sinus – Caused by pressure
within the sinus cavities of the head, usually in connection with
infection of the sinuses. Symptoms include pain and tenderness in the
sinus area, discharge from the nose, and sometimes facial swelling (NIPC
2006). Headache,
tension – This headache
type manifests with mild or moderate pain of variable duration. It
affects both sides of the head and typically is accompanied by
contraction of neck and scalp muscles (NIPC 2006). Headache: Pain in the cranial region that may occur as an isolated
and benign symptom or as a manifestation of a wide variety of conditions
including subarachnoid hemorrhage; craniocerebral trauma; central
nervous system infections; hypertension; and other disorders. (NIH) Hematoma:
A localized collection of blood, usually clotted, in an organ, space, or
tissue, due to a break in the wall of a blood vessel. (EU) Hemorrhage:
The escape of blood from the vessels; bleeding. (EU) Herniated:
Protrusion of a degenerated or fragmented intervertebral
disc into the intervertebral foramen compressing the nerve root.
(NIH) Herpes
zoster virus (related to shingles) – An
acute viral inflammation of the sensory ganglia of spinal and cranial
nerves. Caused by reactivation of the virus causing chicken pox, herpes
zoster, resulting in vesicular eruption and neuralgic pain, usually on
one side of the body (NIPC 2006, MedlinePlus 2006). Hyperalgesia
– An abnormally painful
response to a normally painful stimulus. Hyperesthesia
– Increased sensitivity to
stimulation. Hyperpathia – A syndrome characterized by an abnormally painful and exaggerated reaction to a stimulus, especially a repetitive stimulus. Hypersensitivity
Pain Disorder (HPD) – A
suggested category (possibly transient) denoting chronic pain with
signs/symptoms typical of neuropathic pain mechanisms; however, due to
limitations of currently available diagnostic tools, it does not achieve
the level of a clinical definition of neuropathic pain. Hypoalgesia
– Diminished pain in
response to a normally painful stimulus. Hypoesthesia
– Decreased sensitivity to
stimulation. Immune
response: The activity of the immune system against foreign substances
(antigens). (NIH) Iatrogenic
– A response, usually
unfavorable, to a medical or surgical treatment induced by the treatment
itself. Immunosuppressive:
Describes the ability to lower immune system responses. (NIH) Incontinence:
Inability to control the flow of urine from the bladder or the escape of
stool from the rectum. (NIH) Inflammation:
A pathological process characterized by injury or destruction of tissues
caused by a variety of cytologic and chemical reactions.
It is usually manifested by typical signs of pain, heat, redness,
swelling, and loss of function. (NIH) Inflammation
– A pathologic process
involving complex chemical and cellular reactions that occurs in tissues
in response to injury or abnormal stimulation. Its cardinal signs—
rubor (redness), calor (heat or warmth), tumor (swelling), and dolor
(pain)—reflect processes directed at destroying/removing injurious
material and at promoting repair and healing. Inflammatory
mediators – These may
include prostaglandins, bradykinin, serotonin, histamine, and other
agents. Imagery
– A method for relieving
pain by using mental images from memory or imagination (NPEC 2006). Intermittent
claudication – This
condition, generally found in older people, is marked by cramping and
pain in a muscular area. This pain, typically in the legs, is produced
by exercise and relieved by rest (NPEC 2006).
Intractable
pain – Intense, usually
chronic and unremitting, pain for which no accepted medical intervention
has provided relief (NPEC 2006). Intrathecal
– Within either the subarachnoid or subdural space Intervertebral:
Situated between two contiguous vertebrae. (EU) Intervertebral Disc Displacement:
An intervertebral disc in which the nucleus pulposus has protruded
through surrounding fibrocartilage. (NIH) Intrathecal:
Describes the fluid filled space between the thin layers of tissue that
cover the brain and spinal cord. Drugs
can be injected into the fluid or a sample of the fluid can be removed
for testing. (NIH) Invasive:
Involving puncture or incision of the skin or insertion of an instrument
or foreign material into the body; said of diagnostic techniques. (EU) IPN
– Inflammatory pain,
resulting from tissue response to disease or injury (pathological
process involved in tissue destruction). Ischemia
– A reduction in local
blood flow due to obstruction of the blood supply. Ischemia: Deficiency of blood in a part, due to functional
constriction or actual obstruction of a blood vessel. (EU) Joint
– In anatomy, the place of
contact, generally moveable, between two or more bones. There are three
structural types of joints: fibrous (connective tissue); cartilaginous
(cartilage); and synovial (cavity) (Stedman’s 2000). Ketamine
– A parenterally
administered anesthetic that produces catatonia, profound analgesia,
increased sympathetic activity, and little relaxation of skeletal
muscles. Can be used for minor surgical procedures in which muscle
relaxation is not required. It is chemically related to phencyclidine
(PCP) and can produce hallucinations; therefore, its use is not as
prevalent as it was when originally used during the Vietnam War
(Stedman’s 2000). Lancinating
pain – A type of
neuropathic pain that manifests as an episodic shooting, stabbing, or
knifelike pain. Lesion: An area of abnormal tissue change. (NIH) Lethargy:
Abnormal drowsiness or stupor; a condition of indifference. (EU) Lidocaine
– An anesthetic that
produces pain relief by blocking signals at nerve endings in the skin.
Lidocaine can be administered topically, as a patch or oral gel, or
injected as a local anesthetic. It is used for pain and discomfort of,
for example, infections of the skin. It also is used in the management
of certain cardiac arrhythmias (NIPC 2006, Stedman’s 2000). Limbic
system – The limbic system
includes structures such as the amygdala, hippocampus, septal nuclei,
hypothalamus, and transitional cortical regions (e.g., cingulate gyrus).
This part of the brain is involved with emotional responses. Local
anesthetic – An anesthetic
that reversibly blocks pain and/or movement nerve signals in a specific
part of the body (see Lidocaine) (MayoClinic.com 2005). Low Back Pain: Acute or chronic pain in the lumbar or sacral
regions, which may be associated with musculo-ligamentous sprains and
strains; intervertebral disc displacement; and other conditions. (NIH) Lumbar:
Pertaining to the loins, the part of the bck between the thorax and the
pelvis. (EU) Lumbar
spondylosis – Degeneration
and/or deformity of the lumbar spine (pertaining to the abdominal
segment of the torso, between the diaphragm and the sacrum (pelvis), or
degenerative disc disease. This may lead to spinal stenosis (narrowing
of the spinal canal), vertebral instability, and/or malalignment, which
may be associated with back pain and/or leg symptoms (Stedman’s 2000,
NIPC 2006). Magnetic Resonance Imaging:
Non-invasive method of demonstrating internal anatomy based on the
principle that atomic nuclei in a strong magnetic field absorb pulses of
radiofrequency energy and emit them as radiowaves which can be
reconstructed into computerized images. (NIH) Meninges:
The three membranes that cover and protect the brain and spinal cord. (NIH) Meningioma:
A type of tumor that occurs in the meninges, the membranes that cover
and protect the brain and spinal cord.
Meningiomas usually grow slowly. (NIH) Meningitis:
Inflammation of the meninges. When
it affects the dura mater, the disease is termed pachymeningitis; when
the arachnoid and pia mater are involved, it is called leptomeningitis,
or meningitis proper. (EU) Metastasis:
The spread of cancer from one part of the body to another.
Tumors formed from cells that have spread are called “secondary
tumors” and contain cells that are like those in the original tumor. Migraine
– A vascular symptom
complex of periodic headache, usually temporal and unilateral in onset.
It is typically associated with irritability, nausea, vomiting,
constipation, or diarrhea. Migraine headaches may occur with or without
aura (prodrome of neurologic symptoms, often visual in nature) (NPEC
2006, NIPC 2006). Migraine,
menstrual – Refers
specifically to migraines that occur within the first two days of the
onset of menstruation (NIPC 2006). Morphine: The principle alkaloid in opium and the prototype opiate
analgesic and narcotic. Morphine
has widespread effects in the central nervous system and on smooth
muscle. (NIH) Morphine
– The principle and most
active alkaloid of opium. Morphine acts directly on synapses of the
arcuate nucleus and the CNS. The soluble salts are used in medicine as
an analgesic, anesthetic, or sedative. It is available in oral
preparations and as rectal suppositories. It may also be given via
subcutaneous, intramuscular, intravenous, or intrathecal injection.
Tolerance, and physical and psychological dependence may develop (NIPC
2006, NPEC 2006). Mu
agonists – Opioids that
bind to m1 and m2 receptors in the brain, spinal cord and, under certain
conditions (e.g., inflammation), the periphery to exert their effects. Multidisciplinary
pain center – An
organization, often existing as a component of a medical school or
teaching hospital, encompassing healthcare professionals and scientists
of varied disciplines, including research, teaching, and patient care
related to acute and chronic pain (NIPC 2006). Multimodal
analgesia – Also known as
“balanced analgesia,” this approach to pain management involves the
use of more than one method or modality of controlling pain (e.g., drugs
from two or more classes, drug plus nondrug treatment) to obtain
additive beneficial effects, reduce side effects, or both. Multiple
sclerosis (MS): A disorder of the central nervous system marked by
weakness, numbness, a loss of muscle coordination, and problems with
vision, speech, and bladder control.
MS is an autoimmune disease in which the body’s immune system
destroys myelin. Myelin is a
substance that contains both protein and fat and serves as a nerve
insulator and helps in the transmission of nerve signals. (NIH) Nerve
block – A form of regional
anesthesia, in which an anesthetic agent is injected near a nerve to
block pain. Nervous system: The entire nerve apparatus composed of the brain,
spinal cord, nerves and ganglia. (NIH) Neuropathy:
A problem in any part of the nervous system except the brain and spinal
cord. Neuropathies can be
caused by infection, toxic substances, or disease. (NIH) Neuroablation
– Destruction of tissue,
typically by surgical, chemical (e.g., phenol), or heat (e.g.,
radiofrequency) lesions. The goal of neuroablative procedures is to
interrupt signal flow between peripheral sources of pain and the brain
or to remove neural structures that contribute to pain. Neurolysis
– A technique for
destroying neural tissue that involves injection of a destructive
chemical or use of cold (cryotherapy) or heat (radiofrequency
coagulation). Neuralgia
– Pain that extends along
the course of one or more nerves. It is a form of chronic pain that can
be difficult to diagnose (NPEC 2006). Neuritis
– Inflammation of a nerve
that can include pain, tenderness, anesthesia and paresthesia,
paralysis, wasting, and loss of reflexes (NPEC 2006). Neuroablative
therapy – Use of various
injectable substances, for example alcohol or phenol, or the use of
controlled heat or cold, to render the nervous system unable to transmit
a pain signal. The nerve destruction may be permanent or the nerves may
grow back in time; this is usually employed only when other therapies
have failed (NPEC 2006, WebMD 2006). Neuropathic
pain –
Pain arising from disease or injury to the thermo-nociceptive component
of the nervous system at any level (peripheral, central, or both).
Peripheral neuropathic pain syndromes include HIV sensory neuropathy,
postherpetic neuralgia (PHN), and diabetic neuropathy. Central
neuropathic pain includes poststroke pain, spinal cord injury pain,
trigeminal neuralgia (5th cranial nerve, one of the largest nerves in
the head), and multiple sclerosis pain (NIPC 2006, MedlinePlus 2006). NMDA
receptors – A type of
glutamate receptor involved in mediating excitatory neurotransmission.
These receptors are thought to play an important role in central
sensitization. Nociceptive
pain – Common but misused
term (means "painful pain"), which might be replaced by
"physiological pain." This may result from activity in neural
pathways caused by potentially tissue-damaging stimuli, including
postoperative pain, arthritis, mechanical low back pain, sickle cell
crisis, sports/exercise injuries, and others (NIPC 2006). Nociceptors
– Sensory receptors that
are preferentially sensitive to tissue trauma or a stimulus that would
damage tissue if prolonged. Nonpharmacologic
therapy – Alternative pain
management approach that includes biofeedback, relaxation therapy,
cognitive/behavioral strategies, acupuncture, and others (NIPC 2006). Nonsteroidal
anti-inflammatory drug (NSAID) –
This type of drug, commonly prescribed for the treatment of arthritis or
other conditions, for example bursitis or tendinitis, reduces
inflammation and pain. NSAIDs block the production of certain body
chemicals that can cause inflammation; they also may relieve the pain of
bruises or headaches. NSAIDs include aspirin, ibuprofen, naproxen, and
many other agents (NIPC 2006, Cleveland Clinic 2004). Onset
of action – The length of
time it takes for a medication to begin working (NPEC 2006). Opiate
– A drug directly derived
from opium, for example, morphine (a natural substance extracted from
opium poppies) and codeine. Pain is relieved by binding primarily to
mu-opioid receptors in the brain and spinal cord (NPEC 2006,
MayoClinic.com 2005, Stedman’s 2000, NIPC 2006). Opioid
– A more inclusive term for
naturally derived opiates and synthetic or semisynthetic agents with
analgesic properties similar to opiates. Opioid
agreement – This is a
consensual, written contract, promise, or accord between the patient and
the healthcare provider intended to enhance therapeutic adherence to
opioids. Also known as an Opioid Contract or Medication Agreement (NIPC
2006). Opioid,
long-acting – Agents with a
half-life of many hours or in extended release formulation, and
typically used for persons with chronic pain, for example in cancer, and
for management of non-cancer pain associated with arthritis, back
disorders, fibromyalgia, and multiple sclerosis (NIPC 2006). Opioid
rotation – Strategy of
switching opioids, thereby allowing any opioids causing toxicity or no
longer helping to manage pain to be eliminated while still maintaining
the analgesic effect. The optimal dose should avoid under-dosing or
overdosing, both associated with negative outcomes for the patient. This
requires the use of equianalgesic dose tables, to determine new dosage,
ensuring that pain is well controlled (NIPC 2006). Opioid,
short acting – Agents
typically with a half-life of but a few hours and most commonly used for
the treatment of acute (sudden onset) or breakthrough pain, for example,
post-operative, dental, or trauma-associated pain (NIPC 2006). Opium
– The gum formed by the
drying juice from the unripened fruit (pods) of the poppy (Papaver
somniferum). Opium use as an analgesic predates written history; most
likely originating in Opiate: A remedy containing or derived from opium; also any drug
that induces sleep. (NIH) Opium:
The air-dried exudate from the unripe seed capsule of the opium poppy.
Opium has been used as an analgesic, antitussive, antidiarrheal,
and antispasmodic. (NIH) Osmosis:
Tendency of fluids to move from the less concentrated to the more
concentrated side of a semipermeable membrane. (NIH) Osteoarthritis
– A noninflammatory
(low-grade) degenerative joint disease, predominately occurring in older
persons (80% of people will present with radiographic evidence by age
65). It is characterized by degeneration of articular cartilage (which
covers and acts as a cushion inside the joints), hypertrophy (increase
in size) of bone at the margins, and changes in the synovial membrane
(soft tissue that lines non-cartilaginous surfaces within joints with
cavities). Osteoarthritis is accompanied by pain and stiffness, usually
after prolonged activity or inactivity (Stedman’s 2000, NPEC 2006,
NIPC 2006). Pain
– A popularly used
definition is, "An unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms
of such damage" (Mersky and Bogduk 1994, NIPC 2006). Pain
flares (flare ups) -- pain
that suddenly erupts or emerges with or without a specific aggravating
event or activity. Pain
intensity scales – Systems
of rating pain for adults, children, and infants. Some pain scales are:
Numeric Rating Scale, Wrong-Baker Faces, COMFORT Scale, CRIES Pain
Scale, FLACC Pain Scale, and the Checklist of Nonverbal Indicators (MedlinePlus
2006). Pain
management – The systematic
study of clinical and basic science and its application for the
reduction of pain and suffering. Pain management emphasizes an
interdisciplinary approach to treatment, and combines tools, techniques,
and principles from a variety of the healing arts to create a holistic
paradigm for the reduction of pain and suffering. Pain
pump – Colloquially, a
surgically implanted device in the lower abdomen that provides a steady
stream of medication (typically an opioid) to the cerebrospinal fluid (MayoClinic.com
2005). Pain
scales -- self-report tools
that can help a patient describe the intensity of pain to assist
healthcare providers in measuring the level of pain for diagnostic and
treatment purposes. Three common types of scales include numeric (eg, 1
to 10 scale), verbal (eg, words describing extent of pain), and visual (eg,
expressive pictures of faces). Pain
threshold – The least
amount of pain which a patient can recognize (Mersky and Bogduk 1994). Pain
tolerance level – The
greatest level of pain which a patients is prepared to withstand (Mersky
and Bogduk 1994). Palliative
care (hospice) – Comfort
and/or medical care that reduces the severity of an incurable disease or
slows its progress rather than providing a cure. Typically used to
preserve the patient’s quality of life by avoiding aggressive
end-of-life treatment. These programs can assist the family or
caregiver(s) in making the patient as comfortable as possible, and
assistance is usually available around the clock, seven days a week (NIPC
2006, MedlinePlus 2006). Parenteral
administration –
Administration of a drug via a route other than the gastrointestinal
system, such as by intravenous, intramuscular, or subcutaneous
injection. Paresthesia
– An abnormal sensation
(e.g., “pins and needles” from a foot “going to sleep”), which
may be spontaneous or evoked, and often experienced by patients with
neuropathic pain. Pathologic: Indicative of or caused by a morbid condition. (NIH) Patient-controlled
analgesia (PCA) – The
self-administration of analgesics by a patient; often involves an
intravenous, subcutaneous, or epidural opioid administered via a pump
mechanism. PDN
– Painful diabetic neuropathy. Perforation: The act of boring or piercing through a part.
A hole made through a part or substance. (EU) Perioperative
pain – Pain that is present
in a surgical patient because of preexisting disease, the surgical
procedure (e.g., associated drains, chest or nasogastric tubes,
complications), or a combination of disease-related and
procedure-related sources. Peripheral
neuropathy – A disease or
degenerative state in which motor, sensory, and/or vasomotor nerve
fibers may be affected. This condition may manifest as muscle weakness
and atrophy, pain, and numbness (NIPC 2006). Peripheral
sensitization – A lowering
of the stimulus (pain) threshold for nociceptor activation and an
increase in the frequency of nerve impulse firing (hyperexcitability).
Peripheral sensitization can contribute to pain hypersensitivity found
at the site of tissue damage/inflammation (NIPC 2006). Peridural: Around or external to the dura mater. (EU) Phantom
pain – Pain or discomfort
following amputation that feels to the patient as if it comes from the
missing limb (MayoClinic.com 2005, MedlinePlus 2006). PHN
– Postherpetic neuralgia. Physical
dependence – A physiologic
state of adaptation that often includes tolerance and is manifested by a
drug class-specific withdrawal syndrome that can be produced by abrupt
cessation, rapid dose reduction, decreasing blood levels of the drug,
and/or administration of an antagonist. This should not be confused with
“addiction.” Physiological
pain – Pain arising from a
stimulus (e.g., pinprick, heat pulse) that activates the temperature-
and pain-transmitting (thermonociceptive) nervous system. (Term
sometimes replaces nociceptive pain.) Physiologic: Having to do with the functions of the body. Pneumonia:
Inflammation of the lungs. (NIH) Polyradiculopathy:
Disease or injury involving multiple spinal nerve roots.
Refers to inflammation of multiple spinal nerve roots. (NIH) Polypharmacy
– The administration of
multiple drugs sometimes resulting in excessive medication (NIPC 2006). Postherpetic
neuralgia (PHN) – A painful
condition caused by the varicella zoster virus in the area governed by a
specific sensory nerve after an attack of herpes zoster. PHN usually
manifests after vesicles associated with skin rash have crusted over and
begun to heal. See also, shingles (NIPC 2006). Potency
– The dose or concentration
of a drug required to produce a particular effect (e.g., pain relief). Postoperative: After surgery. (NIH) Prednisolone:
A glucocorticoid with the general properties of the corticosteroids.
It is the drug of choice for all conditions in which routine
systemic corticosteroid therapy is indicated, except adrenal deficiency
states. (NIH) Preemptive
analgesia – A pharmacologic
intervention performed before a noxious event (e.g., surgery) that is
intended to minimize the impact of the stimulus by preventing peripheral
and central sensitization. Primary
afferent (nerve) fibers –
Axons of primary afferent (or “first order”) neurons that transmit
impulses from the periphery toward the central nervous system. Each
neuron has a cell body that resides in sensory ganglia (e.g., dorsal
root ganglia) and a bifurcated axon. One branch extends along a
peripheral nerve and ends in a sensory receptor; the other branch
projects to the spinal cord, where it synapses with a spinal neuron
(e.g., interneuron, projection neuron). Projection
neurons – Neurons in the
dorsal horn of the spinal cord with nerve fibers that project to the
brain in tracts. These neurons are responsible for transmitting
nociceptive information from the spinal cord to higher centers. Progressive: Advancing; going forward; going from bad to worse;
increasing in scope or severity. (EU) Pruritus
– Severe itching; sometimes a side effect of opioid
therapy. Pseudoaddiction
– An iatrogenic syndrome
that may be created by the undertreatment of pain. It is characterized
by patient behaviors such as anger and escalating demands for more or
different medications. Apparent “drug seeking” can be mistaken for
addiction and result in suspicion and avoidance by staff.
Pseudoaddiction can be distinguished from true addiction in that the
behaviors normally resolve when pain is effectively treated (Alford et
al. 2006). Pseudo-opioid
resistance – patients with
adequate pain control may continue to report pain or exaggerate its
presence, as if they have become resistant to opioid analgesic effects,
to prevent reductions in their currently effective doses of medication
(Alford et al. 2006). Pseudotolerance
– The need to increase
analgesic dosage that is not due to tolerance, but due to other factors
such as: disease progression, new disease, increased physical activity,
lack of compliance, change in medication, drug interaction, addiction,
or deviant behavior. When a once-fixed opioid dose is no longer
effective, the above conditions should be reviewed to exclude
pseudotolerance. Psychogenic
pain – Sometimes pejorative
and usually unhelpful term related to unclassified pain experienced by
psychiatric patients. Psychological
dependence – Generally
refers to the mental/cognitive manifestations of substance dependence or
abuse whereby the patient believes there is a need for the drug to
maintain comfort or stability, possibly in the absence of any
physiologic benefit. Radiculopathy
– Caused by compression,
inflammation, and/or injury to a spinal nerve root in the lower back.
Also known as radicular pain or sciatica, the causes of this type of
pain include herniated disc with nerve compression, foraminal stenosis,
diabetes, nerve root injuries, and scar tissue from previous spinal
surgery (NPEC 2006, NIPC 2006). Radiculopathy: Disease involving a spinal nerve root which may
result from compression related to disc displacement; spinal cord
injuries; spinal diseases; and other conditions.
Clinical manifestations include radicular pain, weakness, and
sensory loss referable to structures innervated by the involved nerve
root. (NIH) Referred
pain – Pain felt in a part
of the body other than where the cause is situated. As different nerve
networks converge to common neurons, which relay information to higher
never centers, the brain is not always able to distinguish where
activity initiated (NPEC 2006, NIPC 2006). Reflex
sympathetic dystrophy (RSD) –
More recently known as CRPS (complex regional pain syndrome) this
disorder has been recognized for the past 2,500 years and accepted as
valid for the past 150, but it has yet to be understood. These syndromes
can be characterized by discrete sensory, motor, and autonomic findings,
but many patients with CRPS continue to suffer for years without a
diagnosis. The role of the sympathetic nervous system in maintaining
these syndromes and its appropriateness as a target for treatment
continue to be subjects of controversy (Bennett and Brookoff 2006). Regional
anesthesia – This
interrupts the sensory nerve conductivity to a specific region of the
body. When produced by injection of an anesthetic agent close to the
specific nerve, it is called a nerve block (NPEC 2006). Responsiveness
– The probability of
achieving adequate pain relief with an analgesic without encountering
unmanageable side effects. Rheumatism
– Any of a variety of
disorders marked by inflammation, degeneration, or metabolic derangement
of the connective tissue structures of the body. It is attended by pain,
stiffness, or limitation of motion in joints and related structures,
including muscles, bursae, tendons, and fibrous tissue (NPEC 2006). Rheumatoid
arthritis (RA) – This is an
inflammatory disorder, considered an autoimmune disease that causes
pain, swelling, stiffness, and loss of function in the joints. It has
several features that make it different from other kinds of arthritis,
for example, RA generally occurs in a symmetrical pattern, meaning that
if one knee or hand is involved, the other one also is. While the
disease often affects the wrist joints and the finger joints closest to
the hand, it can also affect other parts of the body besides the joints.
Many people with RA develop anemia, or a decrease in the production of
red blood cells. In addition, people with rheumatoid arthritis may have
fatigue, occasional fevers, and a general sense of malaise (NPEC 2006,
NIPC 2006, MedlinePlus 2006). RSD
– reflex sympathetic
dystrophy, also known as CRPS (complex regional pain syndrome) can be
characterized by discrete sensory, motor, and autonomic findings, but
many patients continue to suffer for years without a diagnosis. The role
of the sympathetic nervous system in maintaining these syndromes and its
appropriateness as a target for treatment continue to be subjects of
controversy. Recent insights into how the nervous system responds to
injury are beginning to explain some of the "impossible"
neurological findings that are characteristic of RSD/CRPS. Case-series
studies suggest that spinal cord stimulation is a safe and effective
treatment for many people with advanced RSD/CRPS who have not obtained
adequate relief with other treatments (Bennett and Brookoff 2006). Sciatica
(see also Radiculopathy) – A
syndrome characterized by pain radiating from the back into the buttock
and lower extremity along its posterior or lateral aspect. It is most
commonly caused by protrusion of a low lumbar intervertebral disk, but
the term can be used to refer to pain anywhere along the sciatic nerve (NPEC
2006). Sclerosis: A pathological process consisting of hardening or
fibrosis of an anatomical structure, often a vessel or a nerve. (NIH) Screening:
Checking for a disease when there are no symptoms. (NIH) Selective
serotonin reuptake inhibitors (SSRIs) –
Medications used to relieve depression by increasing the availability of
serotonin in the brain. By increasing this chemical’s availability,
these drugs modify neuronal pathways involved in regulating mood (MayoClinic.com
2005, MedlinePlus 2006). Sensory loss: A disease of the nerves whereby the myelin or
insulating sheath of myelin on the nerves does not stay intact and the
messages from the brain to the muscles through the nerves are not
carried properly. (NIH) Septic:
Produced by or due to decomposition by microorganisms; putrefactive. (EU) Shingles
– An acute viral
inflammation of the sensory ganglia of spinal and cranial nerves caused
by reactivation of the virus causing chicken pox, herpes zoster, and
resulting in dermatitis with vesicular eruptions and neuralgic pain,
usually on one side of the body (NIPC 2006, MedlinePlus 2006). Shock: The general bodily disturbance following a severe injury; and
emotional or moral upset occasioned by some disturbing or unexpected
experience; disruption of the circulation, which can upset all body
functions: sometimes referred to as circulatory shock. (NIH) Sicca
syndrome -- An autoimmune
disease, also known as Sjögren syndrome, that classically combines dry
eyes, dry mouth, and another disease of connective tissue such as
rheumatoid arthritis (most common), lupus, scleroderma, or polymyositis.
About 90% of Sjögren syndrome patients are
female, usually in middle age or older. Inflammation of the the lacrimal
glands leads to decreased tears and dry eyes. Inflammation of the
salivary glands leads to dry mouth. The syndrome can consequently be
complicated by infections of the eyes, breathing passages, and mouth. Sjögren
syndrome -- see Sicca
syndrome (above). Side effect: A consequence other than the one for which an agent or
measure is used, as the adverse effects produced by a drug, especially
on a tissue or organ system other than the one sought to be benefited by
its administration. (EU) Smooth muscle:
Muscle that performs automatic tasks, such as constricting blood
vessels. (NIH) Somatic
pain – Pain arising from
tissues such as skin, muscle, tendon, joint capsules, fasciae, and bone. Somatosensory
cortex – A subdivision of
the sensory cortex. Spinal cord: The main trunk or bundle of nerves running down the
spine through holes in the spinal bone (the vertebrae) from the brain to
the level of the lower back. (NIH) Spinal cord injuries:
Penetrating and non-penetrating injuries to the spinal cord resulting
from traumatic external forces (e.g., wounds, gunshot, whiplash
injuries; etc…) (NIH) Spinal
cord stimulator – As a
therapy for certain types of chronic neuropathic pain, the spinal cord
is electrically stimulated to cause a new sensation, for example,
tingling, to block pain from being perceived by the brain (MayoClinic.com
2005, NIPC 2006). Spinal
stenosis – Narrowing of the
vertebral canal, nerve root canals, or intervertebral foramina of the
lumbar spine, usually resulting from soft tissue and bony encroachment
of the spinal canal and nerve roots. Symptoms include pain, paresthesias,
and neurogenic claudication (non-specific limb symptoms) (NPEC 2006,
WebMD 2006). Spinal
Nerve Roots: The paired bundles of nerve fibers entering and leaving the
spinal cord at each segment. The
dorsal and ventral nerve roots join to form the mixed segmental spinal
nerves. (NIH) Spinal Stenosis:
Narrowing of the spinal canal. (NIH) Spondylitis:
Inflammation of the vertebrae. (NIH) Spondylitis
– Name given to a group of
chronic diseases that are forms of inflammatory arthritis primarily
affecting the spine (NPEC 2006, MedlinePlus 2006). Spinothalamic
tract (STT) – Major pathway
by which nociceptive information travels from the dorsal horn of the
spinal cord to the thalamus. Sprains and strains:
A collective term for muscle and ligament injuries without dislocation
or fracture. A sprain is a
joint injury in which some of the fibers of a supporting ligament are
ruptured but the continuity of the ligament remains intact.
A strain is an overstretching or overexertion of some part of the
musculature. (NIH) Stellate
ganglion block – A
procedure to relieve pain caused by overactivity of the sympathetic
nervous system (automatic regulation system, operating without the
intervention of conscious thought) in the upper extremities, head, or
neck. A local anesthetic is injected in the front of the neck;
sympathetic nerves are blocked, while sensory pathways are not (MayoClinic.com
2005). “Stress
hormone” response – A
series of responses to an acute injury or stress that leads to an
increase in the metabolic rate, blood clotting, and water retention;
impaired immune function; and a “fight or flight” alarm reaction
with autonomic features. These responses minimize further damage and
blood loss, promote healing, prevent or fight infection, and reduce
blood flow to vital organs, among other functions. Stenosis: Narrowing or stricture of a duct or canal. (EU) Steroid therapy:
Treatment with corticosteroid drugs to reduce swelling, pain, and other
symptoms of inflammation. (NIH) Subarachnoid:
Situated or occurring between the arachnoid and the pia mater. (EU) Substance
P – A neuropeptide that
activates spinal neurons and enhances their responsiveness to excitatory
amino acids, thus facilitating nociception. Superficial
(cutaneous) somatic pain –
A type of somatic pain associated with ongoing activation of nociceptors
in the skin, subcutaneous tissue, or mucous membranes. Sympathetic
(nervous system) hyperactivity –
Symptoms and signs of sympathetic (autonomic) nervous system
hyperactivity include increased heart rate, blood pressure, and
respiratory rate; sweating; pallor; dilated pupils; nausea; vomiting;
dry mouth; and increased muscle tension. Sympathetic
nerve block – Injection of
anesthetic to relieve pain resulting from abnormal activity in the
sympathetic nervous system (see stellate ganglion block) (MayoClinic.com
2005). Syringomyelia: The presence in the spinal cord of elongated central
fluid containing cavities surrounded by gliosis. (NIH) Syrinx:
A fistula. (NIH) Systemic:
Affecting the entire body. (NIH) Temporomandibular
Joint (TMJ) Disorder – A
condition causing pain and dysfunction in the lower jaw joint and
muscles that control jaw movement. It is often associated with
restricted jaw movement, clicking or popping sounds, muscle spasms, and
grinding of teeth. Trauma to the jaw or temporomandibular joint plays a
role in some TMJ disorders but in most cases the exact cause of the
condition is not clear (NPEC 2006, MedlinePlus 2006). Thalamus
– A portion of the brain
that relays impulses from the sensory nerves, which, in turn, enables
people to feel objects they touch as well as pain (MayoClinic.com 2005).
Therapeutic
dependence – sometimes
patients exhibit what is considered drug-seeking because they fear the
reemergence of pain and/or withdrawal symptoms from lack of adequate
medication therapy; their ongoing quest for more analgesics is in the
hopes of insuring a tolerable level of comfort (Alford et al. 2006). Thermonociceptive
– Relating to the
temperature- and pain-sensing components of the nervous system. Thoracic:
Having to do with the chest. (NIH) Thrombosis:
The formation or presence of a blood clot inside a blood vessel. (NIH) Tissue:
A group or layer of cells that are alike in type and work together to
perform a specific function. (NIH) Tolerance
– A state of adaptation in
which repetitive exposure to a drug induces changes that result in a
diminution of one or more of the drug's effects over time. Topical
agents – Medication applied
to the skin rather than ingested or injected (MayoClinic.com 2005). Tomography: Imaging methods that result in sharp images of objects
located on a chosen plane and blurred images located above or below the
plane. (NIH) Toxic:
Having to do with poison or something harmful to the body. (NIH) Transdermal
– Medication absorbed into
the bloodstream via the skin (MayoClinic.com 2005, NIPC 2006). Tricyclic
antidepressants (TCAs) –
Any of a group of antidepressant drugs that contain three fused benzene
rings, which increase the effectiveness of norepinephrine or serotonin
by inhibiting their uptake by nerve endings, but do not inhibit
monoamine oxidase. TCAs were the most popular antidepressants until the
advent of SSRIs. They are still prescribed for certain types of severe
depression that do not respond to SSRIs (NIPC 2006). Trigger
point injection – A
procedure used to relax a tender muscle, or to reduce muscle pain and
inflammation. The targeted muscle is injected with a local anesthetic
(for example, Lidocaine) and corticosteroid. Also called field block
injection (MayoClinic.com 2005). Trigger
zone/point – Hypersensitive
area on the body where touch or pressure elicits pain (NPEC 2006). Triptans
– A class of drugs for the
treatment of migraine that act as agonists for 5-hydroxtryptamine (5-HT)
receptors. The triptans also help relieve other migraine symptoms, such
as nausea, vomiting, and sensitivity to light, noise, and motion. While
triptans can be effective in relieving migraine for some patients, they
do not prevent future attacks or lessen their frequency (NIPC 2006,
MedlinePlus 2006). Vein: Vessel-carrying blood from various parts of the body to the
heart. (NIH) Ventricles:
Fluid-filled cavities in the heart or brain. (NIH) Vertebrae:
A bony unit of the segmented spinal column. (NIH) Visceral
pain – Pain arising from
visceral organs (e.g., heart, lungs, gastrointestinal tract, liver,
gallbladder, kidneys, bladder). Viscosity:
A physical property of fluids that determines the internal resistance to
shear forces. (EU) Waddell
signs –First described in
1984, they are thought to be indicators of a psychological component to
pain. Also called inorganic or nonorganic signs, these are behavioral
responses during physical examination. The eight original signs include:
1) superficial tenderness; 2) nonanatomic tenderness, 3) pain in
response to axial loading (vertical downward pressure on the top of the
head when standing); 4) back pain in response to simultaneous rotation
of the shoulders and pelvis; 5) improved straight leg raise response
when distracted; 6) weakness not consistent with normal neurologic
function; 7) sensory loss that does not follow a dermatomal pattern
(area of skin supplied by cutaneous branches from a single spinal
nerve); and 8) “overreaction” to the physical examination.
Historically and sometimes inappropriately they have been used to detect
and/or accuse patients with back pain as "malingering" (Fillingim
2005, Stedman’s 2000). Wind-up
pain – Nerve cells in the
spinal cord may release chemicals that intensify the pain, affecting the
strength of the pain signal that reaches the brain. Also known as
sensitization (NIPC 2006). Withdrawal
– The uncomfortable
physical or psychological state experienced when certain substances or
medications are discontinued suddenly in an habituated individual.
Therapeutic medication withdrawal is done gradually over time to
minimize uncomfortable symptoms (MayoClinic.com 2005, Stedman’s 2000). X-ray: High energy radiation used in low doses to diagnose diseases
and in high doses to treat cancer. (NIH) Ziconotide – A calcium channel blocker with analgesic and neuroprotective effects that has been used to help relieve chronic intractable pain. It is a synthetic analog of a constituent of the venom from a tropical marine snail of the genus Conus (C. magus). The brand name for the drug is Prialt®. (NIPC 2005).
|
