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Pain Dictionary

Pain Management Dictionary
Abstinence syndrome – the group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs. Specific symptoms vary from person to person but can include nausea, sweating, tremors etc.Acruplasty – is a minimally invasive treatment for vertebral compression fractures. Through a3mm access port a variety of instruments can access the fractured bone. An arc shaped osteotome allows the creation of a cavity within the injured bone. This cavity can then be expanded further to restore some of the shape of the fractured bone. After the cavity is prepared, bone cement is gently advanced into the space while under the guidance of live x-rays, or fluoroscopy. This bone cement will cure within minutes, and cure the bone pain associated with the fractured vertebrae. The procedure takes no more than a few minutes and the patient typically has immediate relief upon awakening.Activation – in (bio-) chemical sciences generally refers to the process whereby something is prepared or excited for a subsequent reaction.Acupuncture – is a collection of procedures which involves the stimulation of points on the body using a variety of techniques, such as penetrating the skin with needles that are then manipulated manually or by electrical stimulation.

Acute Pain – begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain may be mild and last just a moment, or it may be severe and last for weeks or months. In most cases, acute pain does not last longer than six months and it disappears when the underlying cause of pain has been treated or has healed.

Addiction – is the continued use of a mood altering substance or behavior despite adverse consequences, or a neurological impairment leading to such behaviors.

Adjuvant analgesic – is a medication that is not primarily designed to control pain, but can be used for this purpose. Some examples of adjuvant analgesics are medications like antidepressants and anticonvulsants.

Agonists – is a chemical that binds to some receptor of a cell and triggers a response by that cell. Agonists often mimic the action of a naturally occurring substance.

Algogenic – producing pain.

Allodynia – is a pain due to a stimulus which does not normally provoke pain.

Analgesia – the absence of the sense of pain while remaining conscious.

Analgesics – any member of the group of drugs used to achieve analgesia, relief from pain.

Ankylosing spondylitis – previously known as Bechterew’s disease, (or syndrome) and Marie-Strümpell disease, is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures.

Antagonists – a substance that tends to nullify the action of another, as a drug that binds to a cell receptor without eliciting a biological response, blocking binding of substances that could elicit such responses.

Antidepressant – drugs used for the treatment of depression. Despite their name, they are often used to treat a wide range of other conditions as well.

Antiemetics- a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer.

Antiepileptic drug – a diverse group of pharmaceuticals used in the treatment of epileptic seizures.

Arachnoiditis – is a neuropathic disease caused by inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the central nervous system, including the brain and spinal cord.

Arthritis – is a form of joint disorder that involves inflammation of one or more joints. There are over 100 different forms of arthritis

Behavior modification- is the traditional term for the use of empirically demonstrated behavior change techniques to increase or decrease the frequency of behaviors, such as altering an individual’s behaviors and reactions to stimuli through positive and negative reinforcement of adaptive behavior and/or the reduction of behavior through its extinction, punishment and/or satiation.

Bioavailability – is a subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. By definition, when a medication is administered intravenously, its bioavailability is 100% However, when a medication is administered via other routes (such as orally), its bioavailability generally decreases (due to incomplete absorption and first-pass metabolism) or may vary from patient to patient.

Biofeedback – the process of gaining greater awareness of many physiological functions primarily using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will. Some of the processes that can be controlled include brainwaves, muscle tone, skin conductance, heart rate and pain perception.

Biopsychosocial – is a general model or approach positing that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness.

Board certified in Pain Management – a certification program overseen by the American Board of Medical Specialties (ABMS). The ABMS was originally developed through the Council on Medical Education of the American Medical Association and has 24 member boards.

Botulinum toxin – is a protein and neurotoxin produced by the bacterium Clostridium botulinum. Popularly known by one of its trade names, Botox, it is used for various cosmetic and medical procedures.

Buprenorphine – is a semi-synthetic opioid that is used to treat opioid addiction in higher dosages, to control moderate acute pain in non-opioid-tolerant individuals in lower dosages, and to control moderate chronic pain.

Breakthrough pain – is pain that comes on suddenly for short periods of time [citation needed] and is not alleviated by the patients’ normal pain management.

Complementary and alternative medicine- (or integrative health) is the combination of the practices and methods of alternative medicine with evidence-based medicine.

Capsaicin – Capsaicin is currently used in topical ointments, as well as a high-dose dermal patch (trade name Qutenza), to relieve the pain of peripheral neuropathy such as post-herpetic neuralgia caused by shingles.

Cauda equina syndrome (CES) – is a serious neurologic condition in which there is acute loss of function of the lumbar plexus, neurologic elements (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord.

Causalgia – formerly reflex sympathetic dystrophy or causalgia, is a chronic systemic disease characterized by severe pain, swelling, and changes in the skin

Celiac Plexus – or coeliac plexus, also known as the solar plexus because of its radiating nerve fibers, is a complex network of nerves located in the abdomen, where the celiac trunk, superior mesenteric artery, and renal arteries branch from the abdominal aorta. It is behind the stomach and theomental bursa, and in front of the crura of the diaphragm, on the level of the first lumbar vertebra.

Central nervous system – (CNS) is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals. It contains the majority of the nervous system and consists of the brain and the spinal cord.

Central pain – is a neurological condition caused by damage or malfunction in the Central Nervous System (CNS) which causes a sensitization of the pain system. The extent of pain and the areas affected are related to the cause of the injury, which can include mild car accidents, trauma, spinal cord injury, stroke & rheumatoid arthritis. Pain can either be relegated to a specific part of the body or spread to the entire body.

Central sensitization – is a non-associative learning process in which repeated administrations of a stimulus results in the progressive amplification of a response. Sensitization often is characterized by an enhancement of response to a whole class of stimuli in addition to the one that is repeated. For example, repetition of a painful stimulus may make one more responsive to a loud noise.

Cerebral cortex – is the outermost sheet of neural tissue of the cerebrum of the brain in some vertebrates. It covers the cerebrum and cerebellum, and is divided into left and right hemispheres. The cerebral cortex plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness.

Cervical vertebrae – (singular: vertebra) are those vertebrae immediately inferior to the skull.

Chronic non-cancer pain – pain is that is not associated with cancer.

Chronic non-malignant pain – pain that is not associated with cancer or another critical condition.

Chronic pain – a long lasting pain.

Chronic pain syndrome – is a common problem that is a major challenge to health-care providers because of its complex nature of poor etiology and poor response to therapy. Most consider ongoing pain of 3~6 months are diagnostic. A person may have two or more co-existing pain conditions or wide spread generalized pain. This condition is managed best with a multidisciplinary approach.

Continuous dysesthesia – an unpleasant abnormal sensation produced by normal stimuli.

Controlled substance agreement – an agreement between the patient and provider that the use of controlled substance will only be used as prescribed and not abused in any way.

Corticosteroids – are a class of chemicals that includes steroid hormones naturally produced in the adrenal cortex of vertebrates and analogues of these hormones that are synthesized in laboratories.

COX-2 selective inhibitor – is a form of non-steroidal anti-inflammatory drug (NSAID) that directly targets COX-2, an enzyme responsible for inflammation and pain.

Complex regional pain syndrome – (CRPS) formerly reflex sympathetic dystrophy or causalgia, is a chronic systemic disease characterized by severe pain, swelling, and changes in the skin. It often initially affects an arm or a leg and often spreads throughout the body; 92% of patients state that they have experienced a spread and 35% of patients report symptoms in their whole body.

Cyclooxygenase – (COX) officially known as prostaglandin-endoperoxide synthase (PTGS), is an enzyme that is responsible for formation of important biological mediators called prostanoids, including prostaglandins, prostacyclin and thromboxane. Pharmacological inhibition of COX can provide relief from the symptoms of inflammation and pain. Non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen, exert their effects through inhibition of COX.

Deafferentation – is damage to nerves of the peripheral nervous system, which may be caused either by diseases of or trauma to the nerve or the side effects of systemic illness.

Deep somatic pain – is a type of nociceptive pain. Unlike visceral pain (another type of nociceptive pain), the nerves that detect somatic pain are located in the skin and deep tissues. These specialized nerves, called nociceptors, pick up sensations related to temperature, vibration and swelling in the skin, joints and muscles.

Deep tissue – the muscle and the connective tissue or fascia.

Dermatome – is an area of skin that is mainly supplied by a single spinal nerve.

Disc – a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.

Discectomy – is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. The procedure involves removing the central portion of an intervertebral disc, the nucleus pulposus, which causes pain by stressing the spinal cord or radiating nerves.

Discography – is an invasive diagnostic procedure for evaluation for intervertebral discpathology. It is usually reserved for persons with persistent, severe low back pain (LBP) who have abnormal spaces between vertabrae on magnetic resonance imaging (MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered.

Dorsal horn – grey matter section of the spinal cord that receives several types of sensory information from the body including light touch, proprioception, and vibration

Dorsal horn neuron – neurons that are located in the grey matter of the spinal cord which receive sensory information.

Dysesthesia – often presents as pain but may also present as an inappropriate, but not discomforting, sensation. It is caused by lesions of the nervous system, peripheral or central, and it involves sensations, whether spontaneous or evoked, such as burning, wetness, itching, electric shock, and pins and needles.

Endogenous – substances are those that originate from within an organism, tissue, or cell

Endogenous opioid – produced naturally in the body, such as endorphins, enkephalins, dynorphins, and endomorphins. Morphine, and some other opioids, which are produced in small amounts in the body, are included in this category.

Enkephalin – is a pentapeptide involved in regulating nociception in the body. The enkephalins are termed endogenous ligands, as they are internally derived and bind to the body’s opioid receptors.

Epidural space – is the outermost part of the spinal canal.

Epidural blood patch – is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture (spinal tap).

Equianalgesic – (or narcotic) chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain).

Ergotamine – is an ergopeptine and part of the ergot family of alkaloids; it is structurally and biochemically closely related to ergoline.

Excitatory amino acid – the most prevalent transmitter is glutamate, which is excitatory at well over 90% of the synapses in the human brain

Facet joint- is a synovial joint between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it. There are two facet joints in each spinal motion segment.

Fellowship – is the period of medical training in the United States and Canada that a physician or dentist may undertake after completing a specialty training program (residency).

Field block injection – regional anesthesia by encircling the operative field with injections of a local anesthetic.

Fibromyalgia – (FM or FMS) is characterised by chronic widespread pain and allodynia (a heightened and painful response to pressure). Its exact cause is unknown but is believed to involve psychological, genetic, neurobiological and environmental factors.

Glutamate – is an important neurotransmitter that plays a key role in long-term potentiation and is important for learning and memory.

Headache – is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain.

Headache, cluster – is a condition that involves, as its most prominent feature, an immense degree of pain that is almost always on only one side of the head.

Headache, rebound – usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and can be very painful and are a common cause of chronic daily headache.

Headache, sinus – is inflammation of the paranasal sinuses. It can be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days. It is a common condition, with over 24 million cases annually in the U.S.

Headache, tension – is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches

Herniated disc – is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic (unknown) causes, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings.

Herpes zoster – commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe.

Hyperalgesia – is an increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves. Temporary increased sensitivity to pain also occurs as part of sickness behavior, the evolved response to infection.

Hyperesthesia – (or hyperaesthesia) is a condition that involves an abnormal increase in sensitivity to stimuli of the sense.

Hyperpathia – is a clinical symptom of certain neurological disorders wherein nociceptive stimuli evoke exaggerated levels of pain. This should not be confused with allodynia, where normally non-painful stimuli evoke pain.

Hypersensitivity pain disorder – 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 – or hypalgesia denotes a decreased sensitivity to painful stimuli.

Hypoesthesia – (or hypesthesia) refers to a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli.

Iatrogenesis – is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians, and dentists. Iatrogenesis is not restricted to conventional medicine; it can also result from complementary and alternative medicine treatments.

Inflammation – is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.

Imagery – is an experience that, on most occasions, significantly resembles the experience of perceiving some object, event, or scene, but occurs when the relevant object, event, or scene is not actually present to the senses.

Intermittent claudication – is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.

Interventional pain management or interventional pain medicine – a subspecialty of the medical specialty, pain management, devoted to the use of invasive techniques such as facet joint injections,nerve blocks (interrupting the flow of pain signals along specific nervous system pathways), neuroaugmentation (including spinal cord stimulation and peripheral nerve stimulation), and implantable drug delivery systems.

Intra-articular injection – is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis and occasionally osteoarthritis.

Intradiscal Electrothermal Annuloplasty – a recently developed minimally invasive form of annuloplasty consisting of the insertion in the affected disc of a hollow needle, through which a heating wire is passed; once this has reached the disc, the wire is heated to 90°C for approximately fifteen minutes. The heat is intended to seal any ruptures in the disc wall and may also burn nerve endings, which can make the area less sensitive to pain.

Intractable pain – chronic pain not effected by traditional medicine or surgery.

Intrathecal – is an adjective that refers to something introduced into or occurring in the space under the arachnoid membrane of the brain or spinal cord. For example, intrathecal immunoglobulin production means production of this substance in the spinal cord.

Ischemia – is a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular metabolism (to keep tissue alive)

Joint – the location at which two or more bones connect

Ketamine – a drug used in human and veterinary medicine, primarily for the induction and maintenance of general anesthesia, usually in combination with asedative.

Kyphoplasty – a medical spinal procedure in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures.

Lancinating pain – described as shooting or stabbing sensations.

Lidocaine – a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.

Local anesthetic – a drug that causes reversible local anesthesia, generally for the aim of having a local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well. Also, when it is used on specific nerve pathways (nerve block), paralysis (loss of muscle power) can be achieved as well.

Limbic system (or paleomammalian brain) – a complex set of brain structures that lies on both sides of the thalamus, right under the cerebrum

Lumbar spine- the five vertebrae between the rib cage and the pelvis

Lumbar Spondylosis – is a term referring to degenerative osteoarthritis of the joints between the centre of the spinal vertebrae and/or neural foraminae. If this condition occurs in the zygapophysial joints, it can be considered facet syndrome. If severe, it may cause pressure on nerve roots with subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.

Migraine – a chronic neurological disorder characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms.

Migrane menstral – a migrane caused by the menstrual cycle.

Morphine – a potent opiate analgesic drug that is used to relieve severe pain.

Mu agonists – opioids targeting specifically the m1 and m2 nerve receptors which are located in the central nervous system.

Multimodal analgesia – uses more than one method of pain management. Multiple methods can actually reduce the amount of medications necessary to relieve pain, and can minimize uncomfortable side-effects.

Nerve block – a general term used to refer to the injection of local anesthetic onto or near nerves for temporary control of pain. It can also be used as a diagnostic tool to identify specific nerves as pain generators. Permanent nerve block can be produced by destruction of nerve tissue.

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

Neuritis – Inflammation of a nerve that can include pain, tenderness, anesthesia and paresthesia, paralysis, wasting, and loss of reflexes

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

Neuropathic pain – Pain arising from disease or injury to the thermo-nociceptive component of the nervous system at any level (peripheral, central, or both).

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

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

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.

Onset of action – The length of time it takes for a medication to begin working.

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

Opioid – A more inclusive term for naturally derived opiates and synthetic or semisynthetic agents with analgesic properties similar to opiates.

Occipital nerve block – an injection of a steroid or other medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area.

Opioid – induced hyperalgesia- a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, oxycodone, andmethadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.

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.

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.

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.

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.

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.

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.

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.

Pain tolerance level – The greatest level of pain which a patients is prepared to withstand

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.

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.

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.

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.

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.

Phantom pain – Pain or discomfort following amputation that feels to the patient as if it comes from the missing limb.

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.)

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).

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.

Prolotherapy- is also known as “proliferation therapy,” “regenerative injection therapy,”[1] or “proliferative injection therapy”. It involves injecting an otherwise non-pharmacological and non-active irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.

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.

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.

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.

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.

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.

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.

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

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.

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.

Scoliosis- is a medical condition in which a person’s spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an “S” or a “C”, rather than a straight line.

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.

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.

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’s syndrome- a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands[1] that produce tears and saliva. It is named after Swedish ophthalmologist Henrik Sjögren

Somatic pain – Pain arising from tissues such as skin, muscle, tendon, joint capsules, fasciae, and bone.

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.

Spinal stenosis- an abnormal narrowing (stenosis) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness, paraesthesia, and loss of motor control. The location of the stenosis determines which area of the body is affected.

Spondylitis- inflammation of the vertebra. It is a form of spondylopathy. In many cases spondylitis involves one or more vertebral joints as well, which itself is called spondylarthritis.

Spinothalamic tract- a sensory pathway originating in the spinal cord. It is one component of the anterolateral system. It transmits information to thethalamus about pain, temperature, itch and crude touch. The pathway decussates at the level of the spinal cord, rather than in the brainstem like the posterior column-medial lemniscus pathway and corticospinal tract.

Stellate ganglion block – a procedure that relieves pain the sympathetic nervous system in the upper extremities, neck or head caused by the overactivity. Sympathetic nerves are blocked by local anesthetic, while sensory pathways are not.

Spinal fusion – also known as spondylodesis or spondylosyndesis, is a surgical technique used to join two or more vertebrae. Supplementary bone tissue, either from the patient (autograft) or a donor (allograft), is used in conjunction with the body’s natural bone growth (osteoblastic) processes to fuse the vertebrae.

Spondyloarthropathy – any joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself. However, many conditions involve both spondylopathy and spondyloarthropathy.

Spondylolisthesis – the anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. The variant “listhesis,” resulting from misdivision of this compound word, is sometimes applied in conjunction with scoliosis. These “slips” (aka “step-offs”) occur most commonly in the lumbar spine. Spondylolysis (a defect or fracture of the pars interarticularis of the vertebral arch) is the most common cause of spondylolisthesis.

Substance P – a substance that functions as a neurotransmitter and as a neuromodulator. Specifically, substance P is an undecapeptide – a peptide composed of a chain of 11 amino acid residues. It belongs to the tachykinin neuropeptide family. Substance P and its closely related neuropeptide neurokinin A (NKA) are produced from a polyprotein precursor after differential splicing of the preprotachykinin A gene.

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.

Temporomandibular joint dysfunction – an umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joint, which connects the mandible to the skull. The most important feature is pain and impairment of function, which can cause difficulty eating or speaking. Although TMJ is not life threatening, it can detriment quality of life. TMJ is thought to be very common, with one estimate stating that about 20-30% of the adult population are affected to some degree.[3] It most common in people between 20 and 40 years of age. TMJ is the most common non-dental cause of orofacial pain.

Thalamus- a midline symmetrical structure within the brains of vertebrates including humans, situated between the cerebral cortex and midbrain. Its function includes relaying sensory and motor signals to the cerebral cortex, along with the regulation of consciousness, sleep, and alertness. The thalamus surrounds the third ventricle. It is the main product of the embryonic diencephalon.

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

Thermonociceptive- sensitivity to pain from a heat related injury or exposure to heat.

Tolerance – A state of adaptation in which repetitive use of a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

Topical agents- is a medication that is applied to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes including but not limited to creams, foams, gels,lotions and ointments.

Transcutaneous electrical nerve stimulation (TENS)- is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes. TENS by definition covers the complete range of transcutaneously applied currents used for nerve excitation although the term is often used with a more restrictive intent, namely to describe the kind of pulses produced by portable stimulators used to treat pain. The unit is usually connected to the skin using two or more electrodes. A typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity. Generally TENS is applied at high frequency (>50 Hz) with an intensity below motor contraction (sensory intensity) or low frequency (<10 Hz) with an intensity that produces motor contraction.

Transdermal- a route of administration wherein active ingredients are delivered across the skin for systemic distribution. Examples include transdermal patches used for medicine delivery, and transdermal implants used for medical or aesthetic purposes.

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 SSRIs came to the market. When certain types of severe depression do not respond to SSRIs TCAs are still prescribed.

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

Trigger zone/point – points on the body that are hypersensitive to touch or pressure and usually elicit pain.

Triptans- a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. They were first introduced in the 1990s. While effective at treating individual headaches, they do not provide preventative treatment and are not considered a cure.

Vertabrae- a set of bones that collectively make up the spine.

Vertebroplasty- similar to the kyphoplasty its a medical spinal procedure in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures. It was found not to be effective in treating osteoporosis-related compression fractures of the spine in the only two placebo controlled and randomized clinical trials. The patients in both the experimental and placebo groups of the blinded study reported improvement in their pain, suggesting that the clinical benefit noted in unblinded trials is related to the placebo effect.

Wind-up pain – the perceived increase in pain intensity over time when a given painful stimulus is delivered repeatedly above a critical rate. It is caused by repeated stimulation of group C peripheral nerve fibers, leading to progressively increasing electrical response in the corresponding spinal cord (posterior horn) neurons.

Withdrawal – is the group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs.

Ziconotide (Prialt)- a non-opioid and non-NSAID analgesic agent used for the amelioration of severe and chronic pain. Derived from Conus magus(“Cone Snail”), it is the synthetic form of an conotoxin peptide. In December 2004 the Food and Drug Administration approved ziconotide when delivered as an infusion into the cerebrospinal fluid using an intrathecal pump system.

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