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Pain Management Hawaii |
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Pain Definitions Taken from Dr Barnett’s Site |
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ABCESS - A localized collection of pus in any part of the body.
ABDUCTION - Movement away from midline of body in frontal plane; applied to hip, shoulder, fingers, thumb, and foot.
ABLATIVE SURGERY--Surgical procedures performed on peripheral nerves, the spinal cord, the brain or brain stem that relieve pain by permanent disruption of nerve pathways.
ACCUPUNCTURE--The piercing of specific body sites with needles to produce pain relief.
ACHING BACK - Painful back usually caused by pulled, strained or torn muscles.
ACOUSTIC NEURINOMAS - Benign tumor of the hearing nerve (eighth nerve). A progressively enlarging, benign tumor, usually within the internal auditory canal or hearing nerve.
ACROMEGALY - Disorder marked by progressive enlargement of the head, face, hands, feet, and thorax, due to the excessive secretion of growth hormone.
ACTION TREMOR - A type of tremor that occurs during voluntary movements, such as lifting a cup to one's mouth.
ACTIVA TREMOR CONTROL THERAPY - The therapy uses an implanted device to deliver mild electrical stimulation to block the brain signals that cause tremor. The therapy stimulates the target nuclei in the thalamus via an insulated wire lead with electrodes that are surgically implanted in the brain and connected to a pulse generator that is implanted near the collarbone. The stimulation level can be adjusted to get the most possible tremor control with minimal side effects.
ACUTE - Severe, for a short time.
ADDICTION - Psychological, emotional, or physical dependence on the effects of a drug.
ADJUVANT ANALGESIC DRUG: A drug that is not a primary analgesic but that research has shown to have independent or additive analgesic properties.
AEDs - Antiepileptic drugs.
AFFERENT NEURON - Transmitting impulses to the central nervous system.
AGNOSIA - Absence of the ability to recognize the form and nature of persons and things.
AGRAPHIA - Loss of the power of writing due either to muscular incoordination or to an inability to phrase thought.
AKINESTHESIA - Loss of sense of movement, as in a muscle.
ALGOLOGY - The science and study of pain phenomena. An algologist is a student, investigator, or practitioner of algology.
ALLOGRAFT BONE - Sterile bone derived from another human which is used for grafting procedures.
ALLODYNIA - Pain due to a stimulus that does not normally provoke pain. This derived from the Greek "allo" meaning "other" and "odyne," meaning pain. The original definition adopted by the IASP committee was "pain due to non-noxious stimulus to the normal skin." The latest definition omits the words "to normal skin" in order to remove implication that allodynia applies only to referred pain. The present definition also omits "non-noxious" because a stimulus may be noxious at some times and not at others, (e.g., intact skin vs. sunburned skin) and also because the boundary of noxious stimulation may be hard to delimit. It is best to define allodynia in terms of the response to clinical stimuli. The normal response to the stimulus can always be tested elsewhere in the body, usually in a corresponding part. Note that allodynia involves a change in the quality of a sensation, whether tactile, thermal, or of any other sort. The original response to a stimulus was not pain, but the present response is. There is thus a loss of specificity of a sensory modality. In contrast, hyperalgesia represents an augmented response in a specific mode such as pain. With other cutaneous modalities, hyperesthesia is the term that corresponds to hyperalgesia, and as with hyperalgesia, sensory quality is unaltered. In allodynia the stimulus mode and the response mode differ but not with hyperalgesia.
ALTERNATIVE MEDICINE - The use of various non-drug, non-surgical related therapies. Using natural means of treatment.
ANALGESIA - Absence of pain in response to stimulation that would normally be painful. In common parlance, health science professionals often use this term to mean hypoalgesia, a reduction in the intensity of pain that occurs in response to a normally painful stimulus. Equating the term analgesia with clinical pain relief leads to conceptual confusion. One can relieve a patient's pain without necessarily altering his/her ability to feel a normally painful stimulus.
ANESTHESIA - Absence of all sensory modalities.
ANESTHETIC - Agent/agents that produce regional anesthesia (i.e., in one part of the body) or general anesthesia (loss of consciousness).
ANESTHESIA DOLOROSA - Pain in an area or region that is anesthetic.
ANGINA - Derived from the Latin term "angor" for strangling. Usually employed for pain syndromes associated with cardiac disease and indicates a feeling of oppression or tightness of the throat.
ANNULUS - The tough outer ring of a spinal disk .
ANNULUS FIBROSIS- The tough, fibrous outer casing of the intervertebral disc that holds the nucleus pulposus in place.
ANTERIOR - Front of the body or situated nearer the front of the body.
ANTERIOR APPROACH - When used to approach the cervical, cervicodorsal, dorsal, and lumbar spines, it is designed to provide sufficient surface for multiple segmental spinal fusions; Hodgson, Roaf. For specific cervical spinal explorations and fusions; Southwick and Robinson, Bailey and Badgley, Whitesides and kelly, Henry (to vertebral artery).
ANTERIOR DISPLACEMENT - Forward movement of the superior segment on the inferior one.
ANTERIOR SPINAL FUSION - Approaching the spine from the front, the intervertable disc and/or vertebral body is removed and bone graft is inserted. Some variations of this procedure include the Smith-Robinson, Cloward and dowel procedures.
ANTERIOR SPURRING - Ligament turning to bone on anterior side of vertebral body.
ANTEROLATERAL - Situated or occurring in front of and to the side.
ANTEROLATERAL APPROACH - An approach to the dorsal spine by rib resection to explore the spine anteriorly and in some cases to do spinal fusions and decompressions spinal cord.
ANTIDEPRESSANT - A medicine used to treat depression.
ANXIOLYSIS:Sedation or hypnosis used to reduce anxiety, agitation, or tension.
ANXIOLYTIC:Medication used to reduce anxiety, agitation, or tension.
ARACHNOIDITIS - This is a painful inflammation or swelling of the arachnoid membranes around the nerve roots. This disease occurs when the membrane that is in direct contact with the spinal fluid becomes inflamed. This inflammation causes pain by pressing on the nerves. Doctors are unclear about what causes this condition. Arachnoiditis may be treated with either Medtronic neurostimulation or Medtronic intrathecal pain therapies
ARNOLD-CHIARI MALFORMATION - A condition in which there is displacement of the medulla and cerebellum into the opening in the basilar part of the occipital bone. It is one of the causes of hydrocephalus and is usually accompanied by spina bifida and menigomyelocele.
ARTERY of ADAMKIEWICZ - An important source of blood supply to the lower portion of the spine, usually occurring at T-9 to T-11 level; however, not the only blood supply to the cord at that level.
ARTHRALGIA--Pain in a joint, usually due to arthritis or arthropathy.
ARTHRITIS - Arthritis is not a single disease. Over 100 types of arthritis exist. The name, which means "inflammation of the joint," is a misnomer since the joint is not inflamed in all types of arthritis. And not only joints are affected, but also connective tissue throughout the body can be involved. Muscles and soft tissue of several organs can be part of the inflammatory process as well. Close to one hundred different conditions are classified under arthritis. All have common symptoms of aches and pains in the joints and connective tissue throughout the body. The five most common kinds are: Osteo-arthritis, Gout, Rheumatism, Rheumatoid and Systemic Lupus. Greater detail of each type of arthritis is not give here because the report would be a book. The average practitioner of orthodox medicine does not treat the disease, but the isolated symptoms of the disease. He or she treats an affected joint with injections, x-rays, and drugs as if it was a question of an isolated disease in a joint. Why? Because treating symptoms is the only method orthodox medicine is trained to practice, administering pain-killing drugs which will relieve pain temporarily. But, in the long run, due to their many undesirable side-effects, these drugs only cause more damage and ultimately aggravate the condition instead of improving it. Arthritis is a systemic disease which affects the whole body. Therefore, the only measures that can be successful in correcting the disease, bringing it under control, and accomplishing a lasting cure, must be ones directed at correcting its underlying causes. This can only be accomplished by treating the total body to help overcome the systemic disturbances, normalize the metabolic processes, and help restore all normal functions of the body.
ARTHRODESIS - The fusion of bones across a joint space, thereby limiting or eliminating movement. It may occur spontaneously or as a result of a surgical procedure, such as fusion of the spine.
ARTHROPATHY - Any disease or disorder involving a joint.
ARTHROPLASTY - The surgical remodeling of a diseased or damaged joint.
ATROPHY - The withering of an organ or tissues which had previously been normally developed due to degeneration of cells. This may be due to disease, aging or malnutrition.
AUTONOMIC -- Autonomic nervous system - the part of the nervous system responsible for the control of bodily functions that are not consciously directed; including heart beat, intestinal movements, sweating, etc.
AXIAL SOMATIC PAIN-- axial somatic pain - Also known as nociceptive pain, axial somatic pain results from tissue damage that causes the release of chemicals that mediate pain and inflammation. Axial somatic pain may be successfully treated with Medtronic intrathecal pain therapy.
AXON - The part of a nerve cell that usually sends signals to other nerves or structures.
BACK EXTENSION - Bending backward of the spine.
BACK FLEXION - Bending forward of the spine.
BASIL GANGLIA -- Clusters of neurons deep in the brain that play an important role in movement.
BIOFEEDBACK--A process in which a person learns to influence reliably physiologic responses of two kinds: those that are not ordinarily under voluntary control or those that ordinarily are easily regulated but for which regulation has broken down because of trauma or disease.
BONE SCAN--A procedure in which a concentration of radioactive substance that has an affinity for specific tissue is injected into the blood stream to enhance the images of bone activity. This exam will be ordered when the physician suspects a possible infection, recent fracture and/or tumor. A few hours prior to the exam, a tracing substance will be injected into a vein in the arm. The patient will then go to the Nuclear Medicine Department where he/she will lie flat on a table. A scanner will move slowly over the body taking pictures. The exam takes approximately 1-1/2 hours to complete and subjects the patient to very little radiation.
BOTOX: one of the seven isomers of the botulinum toxin produced by the clostridium botulinum bacteria (food poisoning). Usually the A or B toxin are used and are injected directly into muscle in picogram quantities to provide relaxation of the muscle for many months.
BRAIN STEM -- The brain structure that is the major communication route between the brain, spinal cord, and peripheral nerves’ controls heart rate, breathing and other vital functions
BREAKTHROUGH PAIN--Intermittent exacerbations of pain that can occur spontaneously or in relation to specific activity.
BROWN-SEQUARD'S SYNDROME - Loss of sensation of touch, position sense, and movement on the side of a spinal cord lesion, with loss of pain sensation on the other side. Caused by a lesion limited to one side of spinal cord.
BULGING DISC - The annulus portion of the lumbar disc weakens causing the nucleus to press against it resulting in the annulus pinching or pressing against a nerve causing pain.
BURSA-- (plural: bursae) A small sac of tissue located between bone and other moving structures such as muscles, skin, or tendons. The bursa contains a lubricating fluid that allows smooth gliding between these structures.
CARPAL TUNNEL SYNDROME - A condition caused by compression of the median nerve in the carpal tunnel, characterized especially by discomfort and disturbances of sensation in the hand.
CARTILAGE - The hard, thin layer of white glossy tissue that covers the end of bone at a joint. This tissue allows motion to take place with a minimum amount of friction.
CAUDA EQUINA - The bundle of spinal nerve roots arising from the end of the spinal cord and filling the lower part of the spinal canal(from approximately the thoraco-lumbar junction down).
CAUDA EQUINA SYNDROME - Suuficient pressure on the nerves in the low back to produce multiple nerve root irritation and commonly loss of bowel and bladder contraol.
CAUSALGIA - A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes.
CENTRAL CORD SYNDROME - Most common of the incomplete traumatic spinal cord syndromes characterized by motor impairment that is proportionately greater in the upper limbs than in the lower, with bladder dysfunction and a variable degree of sensory loss below the level of the cord lesion.
CENTRAL PAIN - Pain originating in the brain’s central processing center, no longer necessarily affected by nociceptor input. Example: Thalamic pain.
CEREBROSPINAL FLUID (CSF) - Water-like fluid produced in the brain that circulates around and protects the brain and spinal cord. Shrinking or expanding of the cranial contents is usually quickly balanced by increase or decrease of this fluid.
CERVICAL - Of or relating to the neck.
CERVICAL DISC DISEASE-Located between each vertebrae (bone) in the neck is a piece of gelatinous material called the cervical disc. These discs are the shock absorbers of the head and neck. They act as a cushion between the bones and allow bending movements of the head and neck. There are normally six discs in the neck. As we age, these discs gradually become dry and flattened. This is known as degenerative disc disease. The narrower the space between the bones, the less room the nerve has to travel. The nerves may then become irritated, resulting in pain, numbness, tingling or weakness in the arm or hand.
CERVICAL SPINE - Upper spine, neck. Made up of seven vertabrae.
CERVICO-BRACHIAL NEURALGIA-This is a type of pain, which follows the courses of the radial, ulnar or median nerve, may stretch from the base of the neck or the top of the back to the tip of the fingers and is caused by irradiation of abnormal information starting from the ligaments that concern the base of the neck or the top of the back, such ligaments which have been "sprained" by a mechanical accident (wrong movement, impact, etc.). Frequently the accident goes unnoticed. The vertebral sprain may occur when sleeping in a bad position. Pain arising from cervico-brachial neuralgia is one of the most difficult to bear, all the more so because it is exacerbated during the night and insomnia increases the distress of the patient.
CHIROPRACTIC - A therapy which emphasizes proper alignment of the spine.
CHRONIC FATIGUE SYNDROME - An unusual illness, of uncertain cause, that is
CHRONIC LOW BACK PAIN-Duration of low back pain symptoms lasting longer than 3 months
CHRONIC PAIN - Pain that has lasted for more than three months generally having significant psychological and emotional affects and limiting a person's ability to fully function.
CLAUDICATION--There are two types of this. · Neurogenic Claudication , which is pain induced by walking (From the Latin, claudico, to limp). · Vascular Claudication , which is pain induced by walking caused by insufficient blood flow to the legs.
CLUSTER HEADACHE - A chronic headache condition, also called migrainous neuralgia.
COCCYX - The small bone at the end of the spinal column, formed by the fusion of four rudimentary vertebrae. The "tail bone."
COMPLEMENTARY MEDICINE - The use of various non-drug, non-surgical related therapies. Using natural means of treatment.
COMPRESSED NERVE - Material from a bulging or Herniated disk pushes against a nerve in the spinal cord causing severe pain.
CONGENITAL--Present at birth.
CONSCIOUS SEDATION--"Light sedation" during which the patient retains airway reflexes and responses to verbal stimuli.
COLLAGEN - A fibrous protein which is a major constituent of connective tissue. Such as skin, tendons, ligaments, cartilage, and bones.
COMPRESSION FRACTURE - a spinal fracture that results from compression of the vertebra occurring at any level.
COMPLEX REGIONAL PAIN SYNDROME- - Formerly known as reflex sympathetic dystrophy (RSD), this disease most often occurs after an injury (such as a fractured bone). "Complex regional" refers to the fact that the pain is located in one region of the body (such as an arm or leg); however, the condition can spread to additional areas. Because this disease affects the sympathetic nervous system which in turn affects all tissue levels (skin, bone, etc.), there are many symptoms that may occur. The one overriding symptom is extreme pain, other symptoms vary but can include loss of function, skin and temperature changes, swelling, and sensitivity to touch. Complex Regional Pain Syndrome may be successfully treated with Medtronic neurostimulation or Medtronic intrathecal.
COMPUTERIZED TOMOGRAPHY (CT) SCAN - or computer assisted tomography (CT or CAT scan) is a form of radiology or X-ray which uses computers to construct two-dimensional pictures of selected body parts. Dye may be injected into a vein to obtain a better picture. Other than needle insertion for the dye, this test is painless
CONGENITAL - Present at birth.
CONNECTIVE TISSUE DISORDER -- A variety of inflammatory diseases of connective tissue, the most common of which is rheumatoid arthritis. Much, if not all, of this disease is now attributed to autoimmune processes.
CONSERVATIVE MANAGEMENT - This describes any non-surgical treatment of back pain, e.g. physical therapies, pain killers, traction, exercises, massage.
CONTRAST MEDIUM - Any material (usually opaque to x-rays) employed to delineate or define a structure during a radiologic procedure.
CONTRAST MEDIUM - Any material (usually opaque to X-rays) employed to delineate or define a structure during a radiologic procedure
CORDOTOMY-- surgery to cut some of the fibers of the spinal cord; used to relieve pain.
CORPECTOMY - This is the removal of the entire vertebral body. Cortex: the outer part of the brain responsible for consciousness, motor function, and sensory processing.
CORTEX: the outer part of the brain responsible for consciousness, motor function, and sensory processing.
COSTOCHONDRITIS - Inflammation and pain in the area where the cartilages join the breastbone. COSTOVERTEBRAL ANGLE - Juncture of tissue inferior and lateral to the twelfth rib and vertebral body.
COSTOVERTEBRAL JOINT - Junction of the rib with the thoracic spine.
CRYOTHERAPY--The therapeutic use of cold to reduce discomfort; limit progression of tissue edema; or break a cycle of muscle spasm. Cryotherapy is a form of counterirritation.
CRANIO-SACRAL THERAPY - A manual therapy focusing on manipulation of the bones in the skull and sacrum.
CSF - Cerebrospinal Fluid.
CT SCAN - Computed Tomography. This is an excellent way of showing bony detail by xray.
DEAFFERENTATION PAIN - Pain due to loss of sensory input into the central nervous system, as occurs with avulsion of the brachial plexus or other types of lesions of peripheral nerves or due to pathology of the central nervous system.
DEEP BRAIN STIMULATION - A tremor control therapy for patients with Parkinson's Disease or essential tremors, who do not respond effectively to medications. It is a surgical reversible procedure that involves implanting a device to deliver mild electrical stimulation to block the brain signals that cause tremor.
DECOMPRESSION--A procedure involving surgical excision of bone to relieve nerve root pressure caused either by bone or soft tissue such as a disc.
DECOMPRESSIVE LAMINECTOMY - A decompression done by removing the lamina and spinous process.
DEGENERATION - The process of change, usually with age, in bone or soft tissue. Sometimes referred to as ‘wear and tear’.
DEGENERATIVE DISC DISEASE - The discs undergo a process of change from a supple, flexible structure that allows movement and acts as a cushion, to a stiff and rigid one that restricts the amount of movement and is a less effective cushion. This process can start as early as 20 to 30 years of age and by the 60th year it would be a universal finding on x-ray examination.
DEGENERATIVE JOINT DISEASE -Thinning or narrowing of the disc due to an accumulation of small tears which may lead to bulging
DEKOMPRESSOR – a new device that by using an “intradiscal auger” can actually remove nuclear material thus decompressing a disc.
DENERVATION - An impaired or damaged nerve or nerve root.
DERMATOME - The sensory segmental supply to the skin and subcutaneous tissue.
DESSICATED - Simply means - Dried out, Dehydrated.
DISABILITY--"Disability" refers to a state in which the individual is unable to perform his or her job at the same level of efficiency as before the illness or injury occurred. Disability is not necessarily correlated to the presence or absence of pain or other symptoms.
DISC - The intervertebral disc - cartilaginous cushion found between the vertebrae of the spinal column. It may bulge beyond the vertebral body and compress the nearby nerve root, causing pain. The terms "slipped disc".; "ruptured disc" and "herniated disc" are often used interchangeably even though there are subtle differences.
DISC BULGING--This is where the disc displaces, causing a bulge that can put pressure on a nerve root or even the spinal cord.
DISC DEGENERATION - flattening or "wear and tear" of the disc.
DISCECTOMY - Treatment of a disk injury by surgical removal of all or part.
DISCITIS OR DISKITIS - Inflammation of a disk, especially an interarticular cartilage.
DISCOGRAPHY - A radiographic technique used to evaluate the motion segments of the spine by placing radiopaque contrast material into the nucleus of an intervertebral disc. · The procedure is performed to confirm morphology, or changes, in the normal structure of the vertebra, facets, and discs. The most common finding in a person with symptomatic back pain is annular tear and disc herniation. Although an MRI may show disc herniation and/or a tearing of the tough outer "annulus" of the disc, this procedure is considered to be the "gold standard" confirmatory exam. · The procedure is typically performed under a light sedation. It is important for the patient to communicate with the doctor during the exam. Via a small skin opening, a surgical needle is passed down through the back at the disc level being investigated. The needle will pass through the annulus into the nucleus wherein the contrast material is injected. · Radiographic pictures are taken as the contrast is injected and spreads throughout the nucleus. Any changes in the normal anatomy of the disc are evaluated. If it is suspected that more than one disc is symptomatic, the surgeon may evaluate a level above or below as well.
DISTAL - Situated away from the center of the body.
DISTRACTION- - a pain relief method that takes the attention away from the pain.
DOPAMINE - A chemical substance within the brain that helps in the transmission of messages between brain cells (neurons) involved in the control of movement; one of several neurotransmitters
DORSAL COLUMN - The main, normal sensory tract to the brain.
DORSAL ROOT: the part of the peripheral nervous system which contains the sensory and lies in the bony neuroforamina of the spine where the nerves exit the cell body. The dorsal root carries most of the sensations including pain, temperature, vibration, touch entering the spinal cord. The dorsal root ganglion is the cell body
DOSE - The amount of medicine taken.
DURATION OF ACTION - The length of time that the effect of a medicine lasts.
DYSESTHESIA - A condition in which a disagreeable sensation is produced by ordinary touch, temperature or movement. An unpleasant, abnormal sensation, whether spontaneous or evoked.
DYSFUNCTION - This is simply an abnormal or impaired function, usually talking about nerves and or muscles.
EDEMA - An excessive accumulation of fluid generally in extra cellular.
ELECTROENCEPHALOPGRAHY (EEG) - The study of the electrical currents set up by brain actions; the record made is called an electroencephalogram.
EMG - This is used to record the electrical conductivity between nerves and muscles. One electrode is placed on the index finger and the other is placed on the little finger of the same hand. A small electrical impulse is sent up the index finger, through the arm, down the spinal cord, up the other side of the spinal cord and out through the electrode on the little finger. This impulse is monitored by an oscilloscope and the results are printed as a chart, which then can be compared by a Neurologist.
EPIDURAL - Immediately outside the dura mater. Same as extradural.
EPIDURAL BLOCK--An injection which can be used as a treatment as well as a diagnostic tool to help locate the source of pain. The test is conducted in the Radiology Department by an anesthesiologist, physiatrist, or an orthopedist. The patient is also evaluated before and after the test by either the physician, nurse, or physical therapist. As the patient lies on his/her stomach, the physician anesthetizes either the lumbar or tailbone area. This procedure is similar to a Novocain injection given by a dentist. Another needle is then injected into the appropriate area and injections of various medications are given. At times, the physician may use a dye to help trace the flow of medication. The procedure takes approximately 30 minutes. The patient should alert the physician or nurse if allergic to shellfish, iodine, cortisone, or anesthetic.
EQUIANALGESIC:Having equal pain-killing effect; morphine sulfate, 10 mg intramuscularly, is generally used for opioid analgesic comparisons.
FACET - A small smooth-surfaced end of a bony projection (articular process) that functions as part of a joint.
FACET BLOCK--A diagnostic and therapeutic procedure done to determine how much pain is coming from the facet joints, and also to relieve pain.
FACET JOINT - Each of four joints formed above and below and on either side of a vertebra. The lower bony projection of one vertebra meets the upper projections of the vertebra below it, forming facet joints.
FACET JOINT PAIN- Pain and inflammation of joints within the vertebral column. The pain is usually intensified with spine extension (leaning backwards
FACET JOINT SYNDROME- A constellation of symptoms which result in diffuse pains that do not fit a clear nerve root pattern (e.g. not sciatica), these pains are worsened with movement of the spine, poor posture, often sleep, sometimes associated with cold burning sensations, usually worsened by cold damp weather and are now known to emanate from the tiny medial branch nerves that supply the facet joint.
FAILED BACK SURGERY SYNDROME- - This condition refers to patients who have undergone one or more surgical procedures and continue to experience pain. Some common diagnoses included in this condition are recurring disc herniation, epidural scarring or an injured nerve root. Failed Back Syndrome may be successfully treated with Medtronic neurostimulation or Medtronic intrathecal pain therapies.
FASCIA- A band of connective tissue separating muscles and organs in the body.
FIBROMYALGIA - Fibromyalgia is a condition that causes pain in muscles, joints, ligaments and tendons. Sometimes called fibrositis, this is a common condition that is associated with widespread aching, stiffness and fatigue, and originates in muscles and soft tissues. FIBROSITIS--This is a muscular pain often brought on by a chill. There is normally no evidence of inflammation in these very painful areas. The probable explanation is the muscle fibers tighten up and tension is maintained long enough for muscle by products to accumulate and the situation becomes self-perpetuating.
FLEXION EXTENSION X-RAYS (5 VIEW LUMBAR)--Done to determine the quality of motion in the lumbar spine. While standing, the patient is asked to bend forward, with a rounded back, as far as possible. As the patient holds this position, an x-ray is taken. Patients are asked to go to the limit of motion in both directions so that the physicians can obtain accurate information. Patients may support themselves with hands to prevent pain, if necessary. The exam takes approximately 20 minutes.
FLUOROSCOPY X-ray like imaging (which uses much less radiation) of a part of the body that is displayed on a screen or monitor in the block suite - this facilitates and assures proper placement of the needle and medication. There is also an intensifier, that magnifies the image, and improves the accuracy of the treatment. Furthermore, a hard copy can be made for insurance, medical legal and purposes of comparison.
FORAMEN - A hole or opening that acts as a passageway for nerves or blood vessels.
FORAMINOTOMY - Surgical enlargement of the foramen/foramina
FORAMINAL STENOSIS - Narrowing of a vertebral opening. Frequency - How often medication is taken.
FUSION - This is, the sticking together of two or more vertebrae, using bone taken from the patient's hip or metal plates and screws or both
GILL - Removal of the posterior spinal arch in spondylolisthesis.
GREATER OCCIPITAL NERVE - A branch of the second cervical spinal nerve that innervates the middle portion of the occipital area (at the back of the skull) of the scalp.
HERNIATED NUCLEUS PULPOSUS (HNP) - The extrusion of the central portion (NUCLEUS) of an intervertebral disc through the outer cartilaginous ring (ANNULUS). The herniated portion can compress the spinal cord or nerves in or exiting the spinal canal.
HEMIPLEGIA - Paralysis of one side of the body.
HEMILAMINECTOMY - The excision of only one side of the lamina (right or left) relative to other spinous process.
HORNERS SYNDROME—A collection of symptoms, ptosis, meiosis, anhidrosis, caused by the affectation of the Stellate ganglion. An example of pathology might be a Pancoast tumor that involves both the upper and lower brachial plexus.
HYPERALGESIA - An increased response to a stimulus that is normally painful. Please note two considerations. One is the absence of the word noxious in the definition, because of difficulties in its use. The second is the inclusion of some features of allodynia in the definition. Many cases of hyperalgesia have features of allodynia. The term allodynia pertains when there is not an increased response to a stimulus that normally provokes pain. However, when there is also a response of increased pain to a stimulus that normally is painful, hyperalgesia is the appropriate word. With allodynia the stimulus and the response are in different modes, whereas with hyperalgesia they are in the same mode.
HYPERPATHIA - A painful syndrome, characterized by increased reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold. Hyperpathia may occur with hyperesthesia, hyperalgesia, or dysesthesia. Faulty identification and localization of the stimulus, delay, radiating sensation, and after-sensation may occur. The pain is often explosive in character.
HYPERESTHESIA - Excessive sensibility to touch, pain or other stimuli.
HYPEROSTOSIS--This problem is also associated with OA. It is a radiological diagnosis, defined as the presence of large anterior osteophytes in four or more disc spaces in the absence of disc-spaces recession. The bony overgrowths are most common in the thoracolumbar junction, and could result in segments of spinal fusion. Symptoms are usually absent or minimal but fusion can result in severe immobility but it is not common for severe pain or spinal stenosis to occur.
HYPERTROPHY - An abnormal growth of tissue due to the enlargement of each of the cellular parts without an increase in the number of cells.
HYPERMOBILITY - This is where the spinal joints are too mobile.
HYPOALGESIA - Diminished sensitivity to noxious stimulation.
HYPOESTHESIA - Diminished sensitivity to stimulation, excluding special senses.
HYPOMOBILITY - This is reduced mobility of the spinal joints.
IDET – Intradiscal Electrothermy, placement of a specialized catheter circumferentially within the annulus to apply Radiofrequency generated heat to the annular – nucleus border. This heats, shrinks, hardens, and presumably ablates neural ingrowth and seals annular tears.
ILIAC BONE - A part of the pelvic bone that is above the hip joint and from which autogenous bone grafts are frequently obtained. ILIAC CREST - The large, prominent portion of the pelvic bone at the belt line of the body.
ILIOPSOAS MUSCLE - Large muscles starting at L-1 and becoming wider as it picks up segments from the lower lumbar spine; combines with the iliacus muscle before attaching to the lesser trochanter of the hip.
IMMOBILIZATION - Limitation of motion or fixation of a body part usually to promote healing.
IMPLANTABLE PULSE GENERATOR- - A small device that sends mild levels of electrical pulses for use in spinal cord stimulation. The IPG contains a special battery and electronic circuitry to create these tiny electrical pulses. The IPG is placed under the skin, usually below the collarbone or in the abdomen. The IPG is connected to a special insulated wire called a lead. The lead is placed in the part of the body needing mild electrical pulses. (To add extra length to the lead, an extension may be used.) For Medtronic neurostimulation pain therapy the lead is placed in the spinal column. Medtronic pain therapy controls chronic pain. The IPG may also be called a neurostimulator.
INSTRUMENTATION - Metal supports sometimes used in spinal fusions to help steady your spine while it fuses. Common types of support include plates, rods or screws.
INTERNAL DISC DISRUPTION--A disorder in which chemical irritants released from the disc are thought to contribute to a change in the metabolism of the disc. A discogram is the only test which can be used to distinguish this problem from other abnormal back conditions. All other tests and studies are usually normal. Internal disc disruption never spontaneously subsides, distinct from degenerative disc disease which has x-ray changes over the years and can spontaneously resolve.
INTERNAL FIXATION - The immobilization of bone fragments or joints with implants in order to promote healing or fusion.
INTRACTABLE PAIN--A pain state in which the cause of pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts that have been documented in the physician's medical records - taken from the intractable pain act, USA.
INTRATHECAL - Within a theca or the dura mater membrane that surrounds the spinal canal.
INTRATHECAL PUMP - A method of pain relief which uses a small pump that is surgically placed INTERNAL FIXATION - The insertion of metal rods, wires, pins, screws or plates (or a combination of these) into bone fragments.
INTERSPINOUS LIGAMENT - Ligament between each of the spinous processes.
INTERSPINOUS PSEUDARTHROSIS - Formation of a false joint between two spinous processes.
INTERVENTIONAL PAIN MANAGEMENT--An effort to "intervene" in the body's production and/or transmission of a pain signal to the brain. In most cases, this means identifying and treating the underlying cause of a particular pain or pain complex and, by virtue of encouraging the healing process, the pain is subsequently reduced or resolved. Interventional pain management may involve an invasive procedure to treat and manage pain, typically provided through an injection of an anesthetic, nerve block, spinal cord stimulation, implantation of a drug delivery system, or a neurological procedure.
INTRAMUSCULAR (IM) - Into a muscle.
INTRATHECAL (IC) - Into the spinal cord.
INTRAVENOUS (IV) - Into a vein.
INVASIVE PROCEDURE - A procedure that invades the body through either an incision or a placed instrument.
ISTHMIC - The lesion is in the pars interarticularis. Three types occur: lytic, fatigue fracture of the pars interarticularis; elongated but intact pars interarticularis; and acute fracture of the pars interarticularis.
JOINT - The junction or articulation of two or more bones that permits varying degrees of motion between the bones.
KINESIOLOGY - The study of muscles and their relation to movement and pain relief.
KYPHOSIS - This is simply rounded shoulders.
LAMINA - The portion of bone that extends from the pedicle and curves around to complete the vertebral arch on the right and left sides.
LAMINECTOMY - Removal of one or more entire lamina. Used when greater access is needed to perform a diskectomy. Helps release pressure on the nerve when a disk bulges.
LAMINOTOMY - A surgical procedure where part of the lamina of a vertebra is removed for access to the disk
LANCINATING--Characterized by piercing or stabbing sensations.
LEAD- - The lead used in Medtronic neurostimulation pain therapy is a small medical wire with special insulation. For spinal cord stimulation, it is placed next to the spinal cord through a needle. For peripheral nerve stimulation, it is placed directly on the nerve that’s causing pain. The lead contains a set of electrodes (small electrical contacts) through which electrical stimulation is delivered to the spinal cord or peripheral nerves. This stimulation is often described as tingling.
LHERMITTES SIGN - This refers to a sudden electrical sensation down the neck and back triggered by neck movement.
LIGAMENTS--Fibrous tissue which connects bone to bone.
LOCAL ANESTHETICS - Drugs that block nerve conduction in the region where it is applied.
LORDOSIS - Curvature of the spine with the convexity forward.
LUMBAGO - An imprecise term for low back pain.
LUMBAR SPINE - Lower spine, lower back; usually consists of 5 vertebrae.
LUMBAR PUNCTURE - Puncture made by placing a needle into the subarachnoid space, usually performed in the lumbar spine.
LUMBARIZATION - Partial or complete formation of a free-moving first sacral segment so that it looks like a lumbar vertebra.
LUMBAR KYPHOSIS - Reverse of the normal curve of the low back.
LUMBAR LORDOSIS - Angle made by lines drawn from the superior surface of the first and fifth lumbar vertebra.
LUMBOSACRAL CURVE - A lateral curve with its aspect at or between the fifth lumbar vertebra.
LUMBOSACRAL JOINT ANGLE - Angle between the inferior surface of the fifth lumbar vertebra and the top of the sacrum.
MAGNETIC RESONANCE IMAGING (MRI) - MRI is an advanced way of making pictures of what is inside the brain. It is harmless and involves no radiation. It is performed by lying still in a smaller chamber for about 30 minutes. Because MRI utilizes a very strong magnet, if you have any metal other than dental fillings, you should notify your physician.
MASSAGE THERAPY - A general term to describe various bodywork techniques.
MAXIMUM MEDICAL IMPROVEMENT- The greatest amount of medical improvement that can be achieved following an injury, illness, or procedure. MECHANICAL PAIN -(neck and back) Resulting from strain on muscles, tendons, scar tissue and other structures in the spine MEDIAL - Situated closer to the midline of the body.
MEDIAN NERVE - The nerve formed from the brachial plexus that supplies muscles in the anterior forearm and thumb, as well as sensation of the hand. It may be compressed or trapped at the wrist in carpal tunnel syndrome.
MEDULLA: part of the brainstem connecting the brain to the spinal cord.
MENINGES - The three membranes covering the spinal cord and brain termed dura mater, arachnoid mater and piaa mater.
MICRODISCECTOMY - An open operation using an incision which is one to two inches with the disc removal performed with the aid of an operating microscope.
MINIMALLY INVASIVE SURGERY - Surgery requiring small incision(s), usually performed with endoscopic visualization.
MIXED OPIOID AGONIST/ANTAGONIST:A compound that has an affinity for two or more types of opioid receptors and blocks opioid effects on one receptor type while producing opioid effects on a second receptor type.
MRI - Magnetic Resonance Imaging - Scanning technique for views of the brain or spinal cord. No radiation is involved, but rather pulsed magnetic waves are used to delineate the structures within the brain.
MUSCLES RELATED TO BACK PAIN
MUSCLE SPASM - A muscle spasm is defined as "a sudden violent involuntary contraction of a muscle or a group of muscles. A muscle spasm is attended by pain and interference with function, producing involuntary movement and distortion." The most common or familiar form of muscle spasm is the involuntary contraction of a leg muscle. Next in line are those muscles which may be stained beyond their normal level of endurance such as the back muscles. When the muscles spasm, they freeze in contraction and become a hard knotty mass rather than normally contracting and relaxing in quick succession. When this occurs, the blood vessels that normally feed the muscles and supply oxygen constrict - which compounds the problem even more. The physiology of the body, including the contracting and relaxing of the muscles, is under the direct control of the nervous system. Any interference with the normal flow of the nerve energy between the brain and the muscles can result in spasms. Severe examples of this are seen in stroke cases where there is damage to brain. Fortunately, most muscle spasms are due indirectly to minor disturbances of the flow of nerve energy between the brain and the muscles and are readily treatable.
MUSCLE RELAXANTS--Medications that reduce contractibility of muscle fibers, which in turn may relieve some types of muscle spasm.
MYELINATED: refers to nerves which are surrounded by myelin, a substance which protects the nerves, increases nerve impulse transmission speed, and serves as a guide for nerve growth after injury.
MYELOGRAM - A myelogram may be helpful in patients who have neck or back pain or suspected spinal tumors. Dye is injected into the spinal canal, making the structure clearly visible to X-rays. This test requires hospitalization.
MYELOMENINGOCELE - A protrusion of the spinal cord and its coverings through a defect in the vertebral column.
MYELOPATHY - Any functional or pathologic disturbance in the spinal cord.
MYOFASCIAL PAIN- Myofascial pain syndrome refers to pain and inflammation in the muscles (soft tissues). The symptoms are usually those of muscle pain with specific trigger/tender points that can be made worse with activity or stress.
MYOFASCIAL RELEASE - Releasing the fascia (the sheath around a muscle) by gentle movements.
MYOPATHY - Any disease of muscle.
NEOPLASM - Any new or abnormal growth, specifically a new growth of tissue in which the growth is uncontrolled.
NERVE--One or more bundles of impulse-carrying fibers that connect the brain and the spinal cord with other parts of the body. Nerves transmit impulses to and from the brain to organs and extremities.
NERVE CONDUCTION STUDIES -Tests of peripheral nerves performed by stimulating the nerve at one point and measuring the action potential either at another point along the nerve (sensory conduction) or of the muscle innervated by the nerve (motor conduction). NEUROGENIC CLAUDICATION -Symptoms of leg pain (and occasionally weakness) on walking or standing, relieved by sitting or spinal flexion, related to neural compression, usually spinal stenosis.
NERVE COMPRESSION--A pathologic condition that causes pressure on nerves, resulting in possible nerve damage and muscle weakness or atrophy. Modification of causative activities, such as body mechanics, often heals nerve damage caused by compression. Surgery may be required to correct more severe cases.
NERVE ROOT - The end of a spinal nerve nearest its attachment to the spinal cord.
NEURAL ARCH - The bony arch of the posterior aspect of a vertebra that surrounds the spinal cord, also referred to as the vertebral arch.
NEURALGIA - A paroxysmal pain extending along the course of one or more nerves.
NEURECTOMY - Excision of part of a nerve.
NEUROLYSIS - Removal of scar or reactive tissue from a nerve or nerve root.
NEURITIS - Inflammation of a nerve; may also be used to denote non-inflammatory nerve lesions of the peripheral nervous system.
NEUROMA - A tumor or new growth largely made up of nerve fibers and connective tissue.
NEUROABLATIVE--destroying a nerve or part of the nervous system to prevent the transmission of signals.
NEUROGENIC PAIN--Pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in the peripheral or central nervous system.
NEUROGRAPHY: injection of a contrast agent on a nerve root to observe the contrast moving into the spinal canal. Foraminal stenosis is seen as a narrowing in the contrast pattern on x-ray.
NEUROSTIMULATOR-- A neurostimulator is either an IPG (See Implantable pulse generator ) or is a small radio frequency system. Both of these systems are surgically placed under the skin to send mild electrical impulses to the spinal cord or to the specific nerve that is causing pain. The electrical impulses are delivered through a lead (a special medical wire) that is also surgically placed. These electrical impulses block the signal of pain from reaching the brain.
NEUROLYTIC BLOCK--The injection of a chemical agent to cause destruction and consequent prolonged interruption of peripheral somatic or sympathetic nerves, or in some cases, the neuraxis.
NEUROMODULATORY--changing the function of a nerve or part of the nervous system in a reversible manner such that the transmission of signals across that part of the nervous system is either enhanced or inhibited. NEUROPATHIC PAIN - Any pain syndrome in which the predominating mechanism is a site of aberrant somatosensory processing in the peripheral or central nervous system. Some clinical neuroscientists restrict this definition to pain originating in peripheal nerves and nerve roots.
NEUROPATHY - Any functional or pathologic disturbance in the peripheral nervous system. Localized secondary to lesion or generalized secondary to medical disorder. in one nerve, mononeuropathy; in several nerves, mononeuropathy multiplex; if symmetrical and bilateral, polyneuropathy. Although neuritis has been used interchangeably with neuralgia and neuropathy in the past, it is not reserved for inflammatory process affecting nerves. Neuropathy does not cover cases like neurapraxia or neurotmesis.
NEUROSURGEON - A physician who specializes in operations on the brain, nerves, and spinal cord.
NEUROTRANSMITTER: a chemical substance that serves to conduct signals between nerves or nerves and muscle. Common neurotransmitters include acetyl choline, norepinephrine, dopamine, glutamate, glycine, GABA. Neurotransmitters are produced in the nerve ending and diffuse to receptors on the adjacent nerve.
NOCICEPTOR - A receptor preferentially sensitive to a noxious stimulus or to a stimulus that would become noxious if prolonged. One should avoid use of terms like pain receptor, pain pathway, etc because they reflect anachronistic concepts and can mislead. Pain is a complex perception that takes place only at higher levels of the central nervous system.
NONPRESCRIPTION (over-the-counter) - Pain relievers, analgesics that can be bought without a doctor's order.
NON-UNION - Failure of the fragments of a fractured bone to heal or to obtain bony fusion following an arthrodesis.
NOXIOUS STIMULI - A noxious stimulus is one that is potentially or actually damaging to body tissue. In the true Sherringtonian sense, a noxious stimulus is defined as "one of intensity and quality which are adequate to trigger a nociceptive reaction of an animal, including the feeling of pain in humans." In some instances there is no lasting tissue damage (e.g., muscle pain due to excessive exercise).
NSAID--Aspirin-like drug that reduces inflammation (and hence pain) arising from injured tissue.
NUCLEOPLASTY – A newer application of “Coablation” to the nucleus of the disc with an intradiscal device. This presumably heats, applies RadioFrequency energy, and “vaporizes” part of the nucleus, allowing it to “shrink” possibly moving it from neural contact points.
NUCLEUS - The soft center of a spinal disk.
NUCLEUS PULPOSIS--The inner portion of the disc which has a gel-like consistency and is surrounded by the annulus fibrosis.
OCCIPUT - The back part of the head.
OCCIPITAL NERVE - Nerve from the back of the neck that supplies motor function and sensation to the forehead; two parts- greater and lesser.
ONSET OF ACTION - The length of time it takes for a medicine to start to work.
OPIATE - Pain-killing drug chemically related to opium; also called a narcotic.
OPIATE RECEPTOR--Opiate-binding sites found throughout primary afferents and the neuraxis.
OSTEOPATHIC - Particular attention is paid to muscles, joints, bones, and nerves through defined osteopathic manipulations.
OSTEOPHYTES - Bony ridges or spurs. These "growths" can form on all joints in the spine.
OSTEOPOROSIS--A disorder characterized by abnormal loss of bone, occurring most frequently in post-menopausal women, in sedentary or immobilized individuals, and in patients on long-term steroid therapy. The disorder may cause pain, especially in the lower back, pathologic fractures, loss of stature, and various deformities.
PAIN - An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of tissue damage, or both. This is the formal IASP definition.
PAIN THRESHOLD - The least experience of pain that a subject can recognize. Traditionally the pain threshold is the least stimulus intensity at which a subject perceives pain in a laboratory experimen t. In psychophysics, a threshold is defined as the level at which 50% of stimuli are recognized. Thus, the pain threshold is the level at which 50% of stimuli are recognized as painful. Properly defined, pain is always the experience of the patient, whereas the stimulus intensity measured by the psychophysicist is an external event. Psychophysicists classically define the threshold in terms of the stimulus, and that limits the usefulness of pain threshold for clinical application. The stimulus is not pain and cannot be a measure of pain outside the confines of psychophysical modeling.
PAIN TOLERANCE LEVEL - The greatest level of pain that a subject is prepared to tolerate. Because he pain tolerance level is the subjective experience of the individual, the same considerations limit the clinical value of pain tolerance level as pain threshold.
PAIN TYPES - · Episodic Pain - This is pain that occurs suddenly and normally only lasts 1 or 2 days. This type of pain is normally caused by disc displacements commonly known as Slipped Disc's. · Localized Pain - This type of pain occurs at the pain site. For example, Kidney related pain is located in the Kidney area of the body. · Referred Pain - This type of pain occurs somewhere else, other than the pain site. For example, Gall Bladder related pain can be located in the back.
PALLIATIVE THERAPY--A procedure such as chemotherapy, radiation therapy, or surgery that is performed to relieve or ease pain.
PARESTHESIA - Numbness, tingling or a "pins - and - needles" feeling.
PARS INTER-ARTICULARIS - The area between the upper and lower articulating (joining) facets of two vertabrae.
PCA--Patient Controlled Analgesia A system connected to the IV which allows the patient to administer pain mediation that is within the parameters prescribed by the physician. By pushing a button, medication can be released into the bloodstream for immediate pain relief.
PEDICLE - One of the two short stems of bone that project outward from the body of each vertebra.
PERCUTANEOUS - Effected through the skin. Performed through the skin, as with an injection by a needle, or a Rhizotomy with a needle technique.
PERIDURAL FIBROSIS - Scar tissue formation around the dura. This can be as a result of natural degenerative processes or of invasive treatments, such as surgery.
PHASE I, II, III, IV TRIALS -A series of levels of trials required of drugs: Phase I trials assess toxic effects on humans (not many people in them, and usually without controls); Phase II trials assess therapeutic benefit (usually a few hundred people, usually with controls, but not always); Phase III trials compare the new treatment against standard (or placebo) treatment (usually a full randomized controlled trial). At this point, a drug can be approved for community use. Phase IV monitors new treatment in the community (usually a full randomized controlled trial evaluating long-term safety and effectiveness).
PHYSIATRY--A physiatrist (pronounced fizz ee at' trist) is an MD specializing in physical medicine and rehabilitation. They treat a wide range of problems from sore shoulders to spinal cord injuries. The focus of this specialty is restoring function to people. The physiatrists with Texas Back Institute treat both acute and chronic pain and musculoskeletal disorders, but they do not perform surgery. They will design a conservative care treatment plan for you and continue to treat you until you can resume normal activities. Some of the tools they may use for diagnostic testing could include EMG, and nerve conduction studies.
PHYSICAL THERAPY - The health profession that treats pain in muscles, nerves, joints, and bones with exercise, electrical stimulation, hydrotherapy, and the use of massage, heat, cold, and electrical devices.
PHYSICAL MODALITIES--Therapeutic interventions that use physical methods, such as heat, cold, massage, or exercise, to relieve pain.
PIRIFORMIS SYNDROME - A clinical diagnosis based on complaints of pain and abnormal sensations in the buttocks region with extension into the hips and posterior thigh as would be seen in sciatica.
PLIF--Posterior Lumbar Interbody Fusion. An infrequently used surgical procedure in which graft material is inserted into the disc space, as well as in the posterior bony spinal elements.
POLYNEURITIS - Inflammation of two or more nerves simultaneously.
POSTERIOR CERVICAL SPINAL FUSION- Spinal fusion done from the back, using the lamina, facets, and spinous processes of the neck.
PRESCRIPTION PAIN KILLERS - Analgesics that can be bought only with a physician's order.
PROLAPSED DISC - Herniated disk where material from the disk pushes through the outer lining of the disk.
PROSTHESIS - An artificial body part such as an artificial leg or arm. The term prosthesis is also used to describe some of the implants used in the body such as a hip or knee replacement device.
PSEUDARTHROSIS - Failure of fusion to achieve proper union of vertebrae
PSYCHOLOGICAL DEPENDENCE (ADDICTION): Pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief.
PSYCHOSOCIAL INTERVENTION: A therapeutic intervention that uses cognitive, cognitive-behavioral, behavioral, and supportive interventions to relieve pain. These include patient education, interventions aimed at aiding relaxation, psychotherapy, and structured or peer support.
RADICULOPATHY (SCIATICA)-Nerve irritation secondary to disc bulging or inflammation around the nerve root causing shooting pain into the leg ITIS - Inflammation of the spinal nerve roots. Accompanied by pain and hyperesthesia.
RADIOLOGIST--A physician who is specialized in radiographic medicine. This team member performs and interprets selective spinal tests such as CT scans, x-rays, discograms, myelograms, MRI's, and injections. He/she will make recommendations to the members of the Spine Team based on interpretations of these tests.
RADIOFREQUENCY LESIONING - A form of neuroablation, this technique utilizes a finely controlled thermal injury at the tip of a needle to render a painful joint, disc or nerve incapable of sending a pain signal. It is most appropriate for chronic pain of intermediate duration such as terminal cancer pain or an injury capable of restoring within that time frame.
RADIOTHERAPY - Treatment of a lesion with radiation.
REFERRED PAIN--Pain that is felt in a part of the body at a distance from its area of origin.
REFLEX SYMPATHETIC DYSTROPHY - A condition characterized by burning pain, abnormal sensitivity to sensory stimuli, poor circulation and changes in the skin, muscle, bone and joints
RETROLISTHESIS - Posterior displacement of the vertebra on the one below.
RHEUMATOID ARTHRITIS - An inflammatory disease that affects the facet joints in the spine as well as other joints in the body including the hands, elbows, shoulders, fingers and toes.
RHIZOTOMY--A cutting of the roots of spinal nerves within the spinal canal; done for relief of intractable pain.
RIGIDITY - Stiffness of the limbs and joints that makes initiation of movement difficult
RUDIMENTARY RIBS - Nubbins of ribs seen below the level where the last rib normally occurs.
RUPTURED DISC - Herniated disk where material from the disk pushes through the outer lining of the disk.
SACRAL - Five fused segments of the lower spine, below the end of the spinal column, that connect to the pelvis and have four formina on each side.
SACRAL ALA - Lateral portions of the sacral bone.
SACRAL CYST - Abnormality in the spinal fluid sac in the sacrum.
SACRALGIA - Pain in the sacrum.
SACRALIZATION - Fusion of L-5 to the first segment of the sacrum, so that the sacrum consists of six segments; with this abnormality, it is called BERTOLOTTI syndrome
SACRALIZED TRANSVERSE PROCES - One or both of the lumbar spinous transverse processes abnormally joining with the sacrum; sacralization.
SACRODYNIA - Pain perceived to be in the area of the sacrum but may originate elsewhere; reffered pain.
SACROILITIS - Inflammation of the sacroiliac joint. A very painful, often one-sided sacral area pain that follows delivery, is not due to sepsis, and will subside gradually and completely; acute postpardum sacroilitisa.
SACRUM - A part of the spine that is also part of the pelvis. It articulates with the ilia at the sacroiliac joints and articulates with the lumbar spine at the lumbosacral joint. The sacrum consists of five fused vertebrae that have no intervertebral discs. . SACROILIAC JOINT INFLAMMATION -The sacroiliac joint is the union of the sacrum and the iliac bone which may be a source of discomfort.
SCHMORL NODES - Developmental change resulting in inferior or superior extension of the intervertebral disc into the vertebral bodies.
SCIATICA - This is pain that travels into the buttocks, back of the thigh and often into the calf and foot. This is usually caused by an irritation of the nerve root of the sciatica nerve, often from compression by a disc or a degenerative disease.
SCOLIOSIS - This is a lateral (sideways) curving of the spine. This can result in one leg being shorter than the other.
SCS or spinal cord stimulation - Spinal cord stimulation uses a small neurostimulation system that is surgically placed under the skin to send mild electrical impulses to the spinal cord. The electrical impulses are delivered through a lead (a special medical wire) that is also surgically placed. These electrical impulses block the signal of pain from reaching the brain.
SEQUESTRATED DISC--Referring to a portion of the disc material that is separated or isolated from the interior portion of the nucleus pulposus.
SHINGLES - An infection which causes pain along a nerve pathway.
SLIPPED DISC - Herniated disk where material from the disk pushes through the outer lining of the disk.
SOMATIZATION: conversion of anxiety into physical symptoms
SOMATOSENSORY - Derived from Greek word for "body," somatosensory input refers to sensory signals from all tissues of the body including skin, viscera, muscles, and joints. However, somatic usually refers to input from body tissue other than viscera.
SPASM - A sudden, involuntary muscle contraction.
SPINA BIFIDA - A congenital defect of the spine.
SPINAL CORD - An ovoid column of nervous tissue about 44 cm. long, flattened anteroposterioly, extending from the medulla to the 3nd lumbar vertebra in the spinal canal. All nerves to the trunk and limbs are issued from the spinal cord, and it is the center of reflex action containing the conducting paths to and from the brain. In cross section, it does not fill the vertebral space, being surrounded by the pia meter, the cerebrospinal fluid, the arachnoid, and the dura mater, which fuses with the periosteum of the inner surfaces of the vertebrae. The gray substance approximates the shape of an "H", there being a posterior and anterior horn in either half. The anterior horn is composed of motor cells from which the fibers making up the motor portions of the peripheral nerves arise. Sensory neurous enter posteriorly. The "H" also divides the surrounding white matter into posterior, lateral, and anterior bundles. These serve to connect brain and cord in both directions as well as various portions of the cord itself.
SPINAL CORD STIMULATOR--A spinal cord stimulator is an electrical device which is implanted surgically to apply low voltage stimulation to the spinal cord to block the feeling of pain.
SPINAL FUSION - Operative method of strengthening and limiting motion of the spinal column. Can be performed with a variety of metal instruments and bone grafts, or bone grafts alone.
SPINAL INSTABILITY - Damage to a disc or tearing of the ligament holding the spine, which causes the spine to be unable to carry out its supporting function.
SPINAL JOINTS The Spine itself. · Cervical Vertebrae - There are 7 of these joints, each is separated by a disc. · Thoracic Vertebrae - There are 12 of these joints, each is separated by a disc. · Lumbar Vertebrae - There are normally 5 of these joints, but sometimes people are born with only 4 or even 6 of these joints. · Pelvic Bones - There are 3 of these bones which form a joint in front and two joints behind, called Sacroiliac Joints. Parts of the Vertebrae. · Bony Processes (or Protuberances) · Articular Process - These are on top of the Transverse Process and form the top half of the Facet joint. · Transverse Process - These stick out on each side of the vertebrae. · Spinous Process - This is the large bony ridge that sticks out the back of the spine. Other parts. · Lamina - This is the bridge of bone between the Transverse Process & the Spinous Process. · Apophyseal Joint - Also called the Facet Joint or Zygopophyseal Joint and is where the vertebrae sits together at the rear of the spine. · Pedicle - This is at the base of the Articular Process. · Body - This is simply the body of the vertebrae, the disc sits on top of this part. · Spinal Canal - This is simply the hole (or opening) in which the Spinal Cord travels down the spine. · Intervertabral Foramen - This is simply the hole (or opening) in which the Nerve Roots exit the spine. · SPINAL STENOSIS-Narrowing of the nerve opening either around the spinal cord or nerve root that can cause symptoms similar to a pinched nerve. Patients usually have trouble walking, standing, or sitting.
SPINAL TAP - Diagnostic test where a sample of cerebrospinal fluid is "tapped" from an area just below the end of the spinal cord through a thin needle inserted into the spinal canal. Used to detect blood in the CSF.
SPINOUS PROCESS - A bony prominence projecting backward from a vertebra that can be felt under the skin on one's back.
SPONDYLITIS - This is an inflamation of one or more of the vertebrae of the spine. Spondylitis may be due to injury or to some disease, such as arthritis or tuberculosis. Spondylitis is often a chronic, crippling condition leading to, stiffening of the spinal joints (Spondylosis) and deformation (Kyphosis).
SPONDYLOLISTHESIS - Forward displacement or slippage (subluxation) of one vertebra over another.
SPONDYLOSIS - Degenerative bone changes in the spine usually most marked at the vertebral joints with bony spur formation.
SPURLINGS SIGN -This is the reproduction or exacerbation of pain upon pushing down on the head and bending it toward the involved side.
STENOSIS - Narrowing of the openings of the foramen and/or the spinal canal.
STEREOTACTIC SURGERY - Surgical technique whereby the exact target (i.e.tumor, lesion, AVM) is calculated three-dimensionally utilizing CT or MRI and computer. From stereo (3D) and tactic (touch).
SUBARACHNOID - Located under the arachnoid membrane and above the pia mater.
SUBDURAL - Located below the dura mater and above the arachnoid meninges.
SUFFERING - state of emotional distress associated with events that threaten the biological and/or psychosocial integrity of the individual. Suffering often accompanies severe pain but can occur in its absence; hence pain and suffering are phenomenologically distinct.
SUPRASCAPULAR NERVE - The nerve which originates from the superior trunk of the brachial plexus. Supplies the shoulder joint and deep shoulder structures.
SYMPATHECTOMY- Removal of some of the sympathetic nerves.
TENS UNIT--Transcutaneous Nerve Stimulator. A device used to reduce painful stimuli or to stimulate bowel function.
THORACIC - The region of the spine between the neck and the lumbar vertebrae. The ribs connect with the 12 thoracic vertebrae.
THORACIC OUTLET SYNDROME - Mechanical problem related to the exit of arteries and nerves at the base of the neck leading down the arm, and can also involve the vein bringing blood back from the arm.
TOLERANCE - Decreasing effect of a drug with the same dose or the need to increase the dose to maintain the same effect.
TOMOGRAPH - This is a special xray of the spine in which different sections of the vertebrae can be shown.
TRACTION - An old form of conservative treatment that attempts to relieve pain by stretching the spine, in part or as a whole. It can be done by hand or with a variety of machines, some of which turn you upside down.
TRANSVERSE PROCESS - The wing of bone on either side of each vertebral arch where the pedicle meets the lamina.
TRIAL or SCREENING TEST - A Medtronic intrathecal or Medtronic neurostimulation pain therapies screening test is performed prior to long-term implantation of a drug delivery or neurostimulation system to determine whether the patient is a good candidate for the specific therapy. If a good to level of pain relief is achieved during the screening test, long-term implantation is performed.
TRIGEMINAL NERVE - The fifth cranial nerve and the largest. It is mainly sensory except for a small motor branch that supplies the muscles for chewing. The branches of the trigeminal nerve provide sensation to the eye and forehead, midface and upper and lower jaw.
TRIGEMINAL NEURALGIA - Paroxysmal pain in the face. Pain may be so severe that it causes an involuntary grimace or "tic." (Tic Douloureux)
TRIGGER POINTS - A generally small area of a muscle that tightly us knotted and in spasm causing referred pain.
TRIGGER POINT THERAPY - The application of pressure on tender trigger points in the muscles to relieve pain and tension
VERTEBRA - Any of the 33 bones of the spinal column.
VERTEBRAL END PLATES - The top and bottom of the vertebral body that comes into contact with the disc.
X-RAY--Electromagnetic radiation of shorter wave length than visible light. They are produced when electrons, traveling at high speed, strike certain materials. X-rays can penetrate most substances and are used to make photographic images for diagnostic purposes, such as to diagnose degenerative disc disease.
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