Glossary
Acupuncture
A traditional Chinese medical practice of insertion of fine needles into specific exterior body locations to relieve pain, to induce surgical anesthesia, and for therapeutic purposes.
Addiction
Strong physiological and psychological dependence on a drug or other psychoactive substance. A state of heavy dependence on a drug; sometimes defined as physical dependence but usually also including emotional dependence.
Adherence
The act or quality of sticking to something.
Adverse events
Unanticipated problem involving risk to a patient that ultimately results in harm.
Algorithm
A step-by-step method of solving a problem or making decisions, as in making a diagnosis.
Allodynia
Pain resulting from a non-noxious stimulus to normal skin.
Amitriptyline
An antidepressant medication. In some patients with depression, abnormal levels of brain chemicals called neurotransmitters may relate to the depression. Amitriptyline elevates mood by raising the level of neurotransmitters in brain tissue. Amitriptyline is also a sedative that is useful for depressed patients with insomnia, restlessness, and nervousness. It is sometimes used to treat fibromyalgia and symptoms related to chronic pain.
Ankylosing spondylitis
A painful, chronic inflammatory disease that causes inflammation of the joints between the spine and pelvis (sacroiliac joints) and the joints between the vertebrae of the spine. It may also cause inflammation and pain in other parts of the body.
Anticonvulsant
An agent that prevents or relieves convulsions.
Antidepressant
An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monamine oxidase inhibitors.
Antiemetic
An agent that prevents or alleviates nausea and vomiting.
Antiepileptic drug (AED)
An agent that combats epilepsy. It is also used in the treatment of chronic pain.
Arachnoiditis
A condition where dense scar tissue forms around the nerves of the spine causing symptoms such as burning pain, pins and needles, numbness, and weakness.
Arthritis
Inflammation of a joint or a state characterized by inflammation of joints.
Assessment
An evaluation or appraisal, as in pain assessment.
Aura
A subjective sensation or motor phenomenon that precedes and marks the onset of an episode of a neurological condition, particularly a migraine.
Behavioral therapy or behavioral modification
Psychotherapy that is concerned with the treatment (such as by desensitization or aversion therapy) of observable behaviors rather than underlying psychological processes and that applies learning principles to substitute desirable responses and behavior patterns for undesirable ones (such as phobias or obsessions).
Beta-blockers
Any of a group of drugs (such as propranolol) that combine with and block the activity of a beta-receptor to decrease the heart rate and force of contractions and lower high blood pressure and that are used especially to treat hypertension, angina pectoris, and ventricular and supraventricular arrhythmias.
Biopsychosocial
Of, relating to, or concerned with the biological, psychological, and social aspects in contrast to the strictly biomedical aspects of disease.
Botulinum toxin type A (Botox)
A purified botulinum toxin of high molecular weight that is used by injection especially to treat strabismus, blepharospasm, spasmodic torticollis, and severe axillary hyperhidrosis and in cosmetic dermatology and plastic surgery to minimize wrinkles, and in pain management to treat migraines.
Buprenorphine
A synthetic opioid agonist-antagonist derived from thebaine, used as an analgesic for moderate to severe pain and as an anesthesia adjunct; administered sublingually or by intramuscular or intravenous injection.
Calcium channel blocker
Any of a class of drugs (such as verapamil) that prevent or slow the influx of calcium ions into smooth muscle cells, especially of the heart, and that are used especially to treat some forms of angina pectoris, some cardiac arrhythmias, and some types of pain.
Capsaicin
A component of certain plants, including cayenne and red pepper, used topically to relieve minor arthritis pain and nerve pain. It appears to work by reducing a chemical substance found at nerve endings that is involved in transmitting pain signals to the brain.
Causalgia
Intense burning pain and sensitivity to the slightest vibration or touch, usually in the hand or foot, at a site some distance removed from a wound that has healed.
Central sensitization
An increase in the excitability of neurons within the central nervous system, so that normal inputs begin to produce abnormal responses.
Chronic regional pain syndrome (CRPS)
A chronic pain disorder that could be the result of dysfunction in the central or peripheral nervous systems. Symptoms include changes in skin color and temperature over the affected area, intense burning pain, skin sensitivity, sweating, and swelling. These symptoms can vary in severity and length. The pain can spread to the entire arm or leg even if the initiating injury started in a finger or toe.
Coccygodynia (Coccydynia)
Pain in the coccyx region. It can occur following a fall or trauma, or be secondary to low back pain. Muscle spasms can occur in the piriformis, levator ani, and coccygetis muscles.
Combination therapy
The use of two or more therapies, especially drugs, to treat a disease or condition.
Comorbid
Pertaining to a disease or other pathological process that occurs simultaneously with another.
Compliance
The quality of yielding to pressure or force without disruption, as in patient compliance.
Contraindication
Any condition, especially any condition of disease, which renders some particular line of treatment improper or undesirable.
Corticosteroids
Any of the 21-carbon steroids elaborated by the adrenal cortex in response to adrenocorticotropic hormone released by the pituitary gland or to angiostensin II. They are used clinically as an anti-inflammatory agent for pain.
COX-2 inhibitor
Any of a class of drugs (such as celecoxib) that selectively block the isoform COX-2 but not the isoform COX-1 of cyclooxygenase and that are intended to relieve the pain and inflammation of arthritis while minimizing gastrointestinal side effects.
Dependence, physical, physiological
Substance dependence in which there is evidence of tolerance, withdrawal, or both.
Dependence, psychological
Substance dependence in which the drug is used to obtain relief from tension or emotional discomfort, rather than being associated with tolerance or withdrawal.
Diabetic peripheral neuropathy (DPN)
The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes.
Duloxetine
A potent, selective, and balanced inhibitor of serotonin (5-HT) and norepinephrine (NE) reuptake which are involved in pain modulation via descending inhibitory pathways in the brain and spinal cord. It was approved by the FDA in September 2004 for the management of pain associated with diabetic neuropathy, the first drug specifically approved for this indication.
Efficacy
The ability of an intervention to produce the desired beneficial effect in expert hands and under ideal circumstances.
Endometriosis
A disease in which endometrial tissue grows outside of the uterus, resulting in symptoms such as painful monthly periods, pain during intercourse, and chronic pelvic pain.
Epidural anesthesia
Anesthesia produced by injection of a local anesthetic into the peridural space of the spinal cord beneath the ligamentum flavum.
Ergotamine
An alkaloid derived from ergot, consisting of lysergic acid, ammonia proline, phenylalanine, and pyruvic acid combined in amide linkages; used in the treatment of migraine.
Facet joint syndrome
Facet joints are the connections between the bones of the spine. Cartilage cushion in these bones can deteriorate with age or an injury, prompting the joints to rub together. Other causes of facet joint pain include pinching or irritation of the nerves, poor posture, infection, or disc degeneration. Symptoms include tenderness in the lower back, pain when twisting or arching the body, trouble with standing up, neck pain, headaches, shoulder pain, or difficulty rotating the head.
Fentanyl
A synthetic opioid narcotic analgesic with pharmacological action similar to morphine that is administered transdermally as a skin patch and in the form of its citrate is administered orally or parenterally.
Fibromyalgia
A syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia does not cause body damage or deformity. However, undue fatigue plagues the large majority of patients with fibromyalgia and sleep disorders are common.
Frovatriptan
A migraine headache medicine in a class of drugs called serotonin receptor agonists. They are believed to work by causing vasoconstriction (narrowing) of arteries and veins that supply blood to the head.
Gabapentin
An anticonvulsant drug structurally related to gamma-aminobutyric acid that is administered orally as adjunctive therapy in the treatment of partial seizures and for some types of pain.
Gout
A complex form of arthritis of the joints, often in the joint at the base of the big toe, causing sudden, severe attacks of pain. Pain may be most severe within the first 12–24 hours. Afterwards, joint discomfort can last from a few days to a few weeks. Tenderness, redness, and swelling will appear on the affected joint(s).
Headache
A pain in the head with the pain being above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or back ache, has many causes. All headaches are considered primary headaches or secondary headaches. Primary headaches are not associated with other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by other diseases. The associated disease may be minor or major.
Headache, cluster
A distinctive syndrome of headaches, also known as migrainous neuralgia. There are two main clinical patterns of cluster headache -- the episodic and the chronic:
- Episodic: This is the most common pattern of cluster headache. It is characterized by 1-3 short attacks of pain around the eyes per day, with these attacks clustered over a stretch of 1-2 months followed by a pain-free remission, a breathing spell. The average length of remission is a year.
- Chronic: Characterized by the absence of sustained periods of remission, chronic cluster headache may start with no past history of cluster headaches, or it may emerge several years after the patient has experienced an episodic pattern of cluster headaches.
Headache caused by daily use of simple analgesics, opioids, ergotamine, or barbiturate compounds on a daily basis, with worsening of the headaches if the medication was stopped.
Headache, rebound
Headaches experienced by those who have taken ergotamine or analgesic medications for migraines or other health conditions, and who have built up a tolerance for these medications. Often the headache occurs right after the medication wears off. Treatment includes using the medication less frequently, or switching to a different pain reliever. Some patients with acute ergotamide rebound headaches find relief with injected phenothiazine or long-acting steroid medication.
Headache, tension
Headache marked by mild to moderate pain of variable duration that affects both sides of the head and is typically accompanied by contraction of neck and scalp muscles.
Herpes zoster
An acute viral inflammation of the sensory ganglia of spinal and cranial nerves associated with a vesicular eruption and neuralgic pain and caused by reactivation of the herpes virus causing chicken pox. Also known as shingles.
Hyperalgesia
Increased sensitivity to pain or enhanced intensity of pain sensation.
Intervention
Any measure whose purpose is to improve health or to alter the course of a disease.
Intraoperative
Occurring during the course of a surgical operation.
Intrathecal anesthesia
Anesthesia introduced into or occurring in the space under the arachnoid membrane of the brain spinal cord.
Irritable bowel syndrome (IBS)
Irritable bowel syndrome (IBS) is a disorder affecting the large intestine (colon). IBS causes cramping, abdominal pain, bloating gas, diarrhea, and constipation.
Lidocaine
An anesthetic that produces pain relief by blocking the signals at the nerve endings in the skin. Lidocaine topical systems are used to relieve pain and discomfort associated with herpes zoster virus infection of the skin (shingles).
Low back pain
Pain can occur with specific movement, such as lifting or stretching, causing a sprain, spasm, or strain in the muscles or ligaments in the back. A disc may rupture or bulge if the spine is overly strained or compressed. As a result, the nerve roots in the spinal cord become compressed or aggravated, causing back pain. Other causes may include degenerative conditions such as arthritis or disc disease, osteoporosis, viral infections, or congenital abnormalities in the spine. Acute and chronic pain is defined by the presence or absence of neurologic symptoms and signs. Acute pain can persist for ≤1 month while chronic pain can persist for ≥3 months.
Lumbar spondylosis
Degeneration of the lumbar spine is described as lumbar spondylosis or degenerative disc disease and may lead to spinal stenosis (narrowing of the spinal canal), vertebral instability, and/or malalignment, which may be associated with back pain and/or leg symptoms.
Lupus erythematosus
Lupus is a chronic, inflammatory, autoimmune condition that affects any body part, especially the skin, joints, heart, and kidneys. When the autoimmune system cannot distinguish viruses, bacteria, and germs from the body’s healthy tissues, it creates autoantibodies that attack and destroy healthy tissue. Symptoms can last for more than six weeks and sometimes for many years.
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Systemic lupus erythematosus: the most common form of lupus. It may cause coronary artery disease, pulmonary hypertension, and inflammation of the kidneys, brain, and nervous system.
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Cutaneous lupus erythematosus: affects the skin and may cause a raised, scaly, and red discoid rash, usually over the cheeks and across the bridge of the nose (butterfly rash). Hair loss and change in skin pigment may occur.
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Drug-induced lupus erythematosus: caused by certain medications such as hydralazine, procainamide, and isoniazid. The symptoms are similar to those of systemic lupus, but only rarely will any major organs be affected.
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Neonatal lupus: an uncommon condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. The infant may have a skin rash, liver problems, or low blood cell counts at birth, but these symptoms disappear after several months with no lasting effects. Some infants can also have a serious heart defect.
Magentic resonance imaging scan (MRI)
MRI involves a highly technical scanner that uses magnetic fields and computer technology to generate images of the internal anatomy of the body, including discs and nerve roots.
Menstrual migraine
Menstrual migraine refers specifically to those attacks that occur within the first 2 days of the onset of menstruation. Migraine refers to a specific type of severe headache.
Migraine
An often familial symptom complex of periodic attacks of vascular headache, usually temporal and unilateral in onset, commonly associated with irritability, nausea, vomiting, constipation or diarrhea, and often photophobic.
Monochromatic infrared light therapy
A device (for example, hand-held or skin pads) with small infrared lights that helps improve blood flow, decrease pain, and increase sensation or feeling in the applied area. Light travels deep into the body’s tissues and dilates the blood vessels. As blood flow to the area increases, tingling and pulsing may occur.
Morphine
The principle and most active narcotic alkaloid of opium, having powerful analgesic action and some central stimulant action.
Multidisciplinary pain center
An organization of health care professionals and basic scientists which includes research, teaching, and patient care related to acute and chronic pain. This is the largest and most complex of the pain treatment facilities and ideally would exist as a component of a medical school or teaching hospital.
Nerve block
A procedure in which an anesthetic agent is injected directly near a nerve to block pain. A nerve block is a form of regional anesthesia.
Neuroleptics
A term coined to refer to the effects on cognition and behavior of the original antipsychotic agents, which produced a state of apathy, lack of initiative, and limited range of emotion in psychotic patients and caused a reduction in confusion and agitation and normalization of psychomotor activity. The term is outdated as a synonym for antipsychotic agents because newer agents do not necessarily have such effects.
Neuropathic pain
Neuropathic pain is pain caused by a primary lesion or dysfunction in the peripheral and/or central nervous systems. Examples of peripheral neuropathic pain syndromes include HIV sensory neuropathy, postherpetic neuralgia (PHN), and diabetic neuropathy. Examples of central neuropathic pain include central poststroke pain, spinal cord injury pain, trigeminal neuralgia, and multiple sclerosis pain.
Nociceptive pain
Nociceptive, or inflammatory pain, is pain resulting from activity in neural pathways caused by potentially tissue-damaging stimuli. Examples include postoperative pain, arthritis, mechanical low back pain, sickle cell crisis, and sports or exercise injuries.
Nonpharmacologic therapy
An alternative pain management strategy that includes biofeedback, relaxation therapy, cognitive/behavioral strategies, and acupuncture.
Nonsteroidal anti-inflammatory drug (NSAID)
A type of drug commonly prescribed for the treatment of inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. Examples of NSAIDs include aspirin, indomethacin, ibuprofen, naproxen, piroxicam, and nabumetone.
Opioid
Any synthetic narcotic that has opiate-like activities but is not derived from opium.
Opioid agreement
Also called a "contract," a "promise", or an "accord"," it is a consensual agreement intended to improve therapeutic adherence and enhance therapeutic relationships by initiating an alliance between the patient and the physician.
Opioid analgesia
Opioid analgesics, also known as narcotic analgesics, are the most powerful pain relievers that act on the central nervous system. They are the mainstay for treatment of severe acute pain and chronic pain due to cancer and other serious disorders. They are chemically related to morphine, a natural substance extracted from poppies, although some opioids are extracted from other plants and other opioids are produced in a laboratory.
Opioid rotation
Rotating or switching an opioid allows the metabolites and offending opioid to be eliminated while maintaining analgesia with a strong opioid. This strategy can be particularly useful when the toxicity is severe and/or pain is not well controlled. Switching the opioid requires the use of equianalgesic dose tables.
Opioid, long-acting
Used for patients with continuous chronic pain.
Opioid, short-acting
Appropriate for treatment of acute pain or breakthrough/incident pain.
Osteoarthritis
A noninflammatory degenerative joint disease seen mainly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain, usually after prolonged activity and stiffness, particularly in the morning or with inactivity.
Oxycodone
An opioid agonist analgesic derived from morphine derivative.
Oxymorphone
A semi-synthetic compound used as a narcotic analgesic.
Pain, acute
Pain that comes on quickly, can be severe, but lasts a relatively short time.
Pain, chronic
Pain that persists or progresses over a long period of time.
Palliative care
Medical or comfort care that reduces the severity of a disease or slows its progress rather than providing a cure. For incurable diseases, in cases where the cure is not recommended due to other health concerns, and when the patient does not wish to pursue a cure, palliative care becomes the focus of treatment.
Pathophysiology
The physiology of disordered function.
Patient-controlled analgesia (PCA)
A method by which the patient controls the amount of analgesia they receive. In the classic PCA system, the patient receives a preset dose of morphine by pressing a button on a computerized pump that is connected to an IV catheter. With PCA the patient may receive a small continuous flow of morphine and add more morphine as needed to provide a more constant level of comfort.
Peripheral neuropathy
A disease or degenerative state (as polyneuropathy) of the peripheral nerves in which motor, sensory, or vasomotor nerve fibers may be affected and which is marked by muscle weakness and atrophy, pain, and numbness.
Peripheral sensitization
Peripheral sensitization is a reduction in threshold and an increase in responsiveness of the peripheral ends of nociceptors, the high-threshold peripheral sensory neurons that transfer input from peripheral targets (skin, muscle, joints, and the viscera) though peripheral nerves to the central nervous system (spinal cord and brainstem). Peripheral sensitization contributes to the pain hypersensitivity found at the site of tissue damage and inflammation.
Phonophobia
Irrational fear of sounds or of speaking aloud.
Photophobia
Abnormal visual intolerance of light.
Physical therapy
A branch of rehabilitative health that uses specially designed exercises and equipment to help patients regain or improve their physical abilities.
Polypharmacy
The administration of many drugs together or the administration of excessive medication.
Postherpetic neuralgia (PHN)
A painful condition caused by the varicella zoster virus in a dermatomal distribution (the area governed by a particular sensory nerve) after an attack of herpes zoster (HZ) (commonly known as shingles), usually manifesting after the vesicles have crusted over and begun to heal.
Postoperative
Relating to, occurring in, or being the period following a surgical operation.
Pregabalin
3-substituted analogue of gamma-amino butyric acid (GABA) and a compound related to the antiepileptic drug gabapentin, a new anticonvulsant drug indicated as an add-on therapy for partial onset seizures and for certain types of neuropathic pain.
Preoperative
Preceding an operation.
Preventive
Serving to avert the occurence of.
Prophylaxis
Intervention aimed at the prevention of disease.
Pseudoaddiction
Behaviors that appear to indicate addiction but actually reflect undertreated pain.
Psychosocial
Pertaining to or involving both psychic and social aspects.
Radiculopathy
Radiculopathy is caused by compression, inflammation, and/or injury to a spinal nerve root in the low back. Causes of this type of pain, in the order of prevalence, include herniated disc with nerve compression, foraminal stenosis, diabetes, nerve root injuries, and scar tissue from previous spinal surgery. Also known as radicular pain or sciatica.
Referred pain
As different nerve networks converge on to common neurons relaying information to higher nerve centers, the brain is not always able to distinguish where activity in the common neuron was initiated. This type of pain is known as referred pain.
Rehabilitation
The restoration of the ill or injured patient to optimal functional level in the home and community in relation to physical, psychosocial, vocational, and recreational activity.
Rheumatoid arthritis
A usually chronic disease that is considered an autoimmune disease and is characterized especially by pain, stiffness, inflammation, swelling, and sometimes destruction of joints.
Sciatica
Pain that radiates from the lower spine to the buttock and down the back of the leg. Symptoms may include numbness or muscle weakness in the leg or foot, tingling or a pins-and-needles feeling in the toes or foot.
Serotonin antagonists
Drugs that bind to but do not activate serotonin receptors, thereby blocking the actions of serotonin or serotonin agonists.
Sinus headache
A headache caused by pressure within the sinus cavities of the head, usually in connection with infection of the sinuses. Signs and symptoms of sinus headache include pain and tenderness in the sinus area, discharge from the nose, and sometimes swelling of the face.
Sinusitis
Inflammation of a sinus, usually a paranasal sinus; it may be purulent or nonpurulent, acute or chronic.
Spinal cord stimulation
A medical therapy for people who suffer from certain types of chronic neuropathic pain in which electrical impulses are used to block pain from being perceived in the brain. Instead of pain, the patient feels a mild tingling sensation.
Spinal fusion
Surgical fusion of two or more vertebrae for remedial immobilization of the spine.
Spinal stenosis
Spinal stenosis occurs when the spinal canal narrows, compressing the spinal cord or nerves. It can cause cramping, a loss of sensation in your extremities, and sometimes problems with bladder or bowel function. Spinal stenosis is most commonly caused by osteoarthritis-related bone damage, age, or a condition from birth.
Stroke
Sudden diminution or loss of consciousness, sensation, and voluntary motion caused by rupture or obstruction (as by a clot) of a blood vessel of the brain.
Sumatriptan
A selective serotonin antagonist used in the acute treatment of migraine headache.
The 4 A's
A mnemonic device for the relevant domains of outcome for pain management that include analgesia, activities of daily living, adverse effects, and aberrant drug-taking behavior. Successful outcome in pain therapy encompasses more than the lowering of pain intensity scores.
Titration
Determination of a given component in solution by addition of a liquid reagent of known strength until a given endpoint is reached.
Tolerance
The capacity of the body to endure or become less responsive to a substance (such as a drug) or a physiological insult especially with repeated use or exposure.
Topical analgesics
Analgesics designed for or involving application to or action on the surface of a part of the body.
Topiramate
A substituted monosaccharide used as an anticonvulsant in the treatment of partial seizures and more recently migraines.
Tramadol
A synthetic opioid analgesic administered orally in the form of its hydrochloride C16H25NO2•HCl to treat moderate to severe pain.
Transcutaneous eletrical nerve stimulation (TENS)
A TENS unit is a small machine that delivers electrical current into the nerves via electrodes (patches) placed on the skin near the spine. The electrical current breaks up pain messages to the brain and stimulates the body to produce endorphins, which act like a natural “pain killer” to help block pain.
Transdermal
Relating to, being, or supplying a medication in a form for absorption through the skin into the bloodstream.
Tricyclic antidepressants (TCAs)
Any of a group of antidepressant drugs (such as imipramine, amitriptyline, desipramine, and nortriptyline) that contain three fused benzene rings that potentiate the action of catecholamines (such as norepinephrine and serotonin) by inhibiting their uptake by nerve endings and that does not inhibit the action of monoamine oxidase.
Trigeminal nerve
Either of the fifth pair of cranial nerves that are mixed nerves and, in humans, are the largest of the cranial nerves, which arise by a small motor root and a larger sensory root that both emerge from the side of the pons, with the sensory root bearing the trigeminal ganglion and dividing into ophthalmic, maxillary, and mandibular nerves, and the motor root supplying fibers to the mandibular nerve and through this, to the muscles of mastication.
Triptans
A class of drugs for the treatment of migraine that act as agonists for 5-hydroxytryptamine (5-HT) receptors. They are very effective in relieving migraine but do not prevent future attacks or lessen their frequency. The antimigraine activity of the triptans likely lies in their agonist effects on the 5-HT receptors in the intracranial blood vessels and nerves of the trigeminal system which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.
Wind-up pain
Nerve cells in the spinal cord may release chemicals that intensify the pain, affecting the strength of the pain signal that reaches the brain. Also known as sensitization.
Ziconotide
A calcium channel blocker C102H172N36O32S7 with analgesic and neuroprotective effects that has been used to relieve chronic intractcable pain and is a synthetic analog of a constituent of the venom of a tropical marine snail of the genus Conus (C. magus).