CBT – Cognitive Behavioural Therapy
CRPS – Complex Regional Pain Syndrome
GMS – General Medical Services
IRSB – Intravenous Regional Sympathetic Block
LHB – Local Health Board
NHS – National Health Service
NICE – National lnstitute for Health and Clinical Excellence
PCT – Primary Care Trust
PHCT – Primary Healthcare Trust
PCO – Primary Care Organisation
RSD – Reflex Sympathetic Dystrophy
SLR – Straight leg Raising
SNRI – Serotonin-noradrenergic reuptake inhibitors
TCA – Tricyclic antidepressant
TENS – Transcutaneous Electrical Nerve Stimulation
WHO – World Health Organisation
Useful definitions and glossary
Allodynia
Pain due to a stimulus that does not normally provoke pain. For example, stroking the skin lightly with clothes or cotton wool will produce pain.
Pain due to a stimulus that does not normally provoke pain. For example, stroking the skin lightly with clothes or cotton wool will produce pain.
Anterior
Front.
Front.
Ankylosing Spondylitis
A painful, inflammatory disease of unknown origin that causes the sacroiliac joints and spinal vertebrae to fuse (ankylose) together.
A painful, inflammatory disease of unknown origin that causes the sacroiliac joints and spinal vertebrae to fuse (ankylose) together.
Annulus Fibrosus
The tough, fibrous outer casing of the intervertebral disc that holds the nucleus pulposus in place.
The tough, fibrous outer casing of the intervertebral disc that holds the nucleus pulposus in place.
Apophyseal joint
Another name for the facet joint.
Another name for the facet joint.
Arachnoiditis
A disease or condition where dense scar tissue forms around the nerves of the spine causing symptoms such as burning pain, pins and needles, numbness and weakness.
A disease or condition where dense scar tissue forms around the nerves of the spine causing symptoms such as burning pain, pins and needles, numbness and weakness.
Bilateral
On both sides of the bodv.
On both sides of the bodv.
Blood tests
Blood is taken via a hypodermic needle from a vein in the forearm. It is then tested to check for signs of infection, anaemia, rheumatoid arthritis and other inflammatory conditions. The procedure of taking blood is referred to as venepuncture.
Blood is taken via a hypodermic needle from a vein in the forearm. It is then tested to check for signs of infection, anaemia, rheumatoid arthritis and other inflammatory conditions. The procedure of taking blood is referred to as venepuncture.
Bone scan
These may be radio-isotope type (as safe as an x-ray) for tumours, infections and some fractures, or, ultrasound type for osteoporosis and some soft tissue injuries.
These may be radio-isotope type (as safe as an x-ray) for tumours, infections and some fractures, or, ultrasound type for osteoporosis and some soft tissue injuries.
Cauda equina
This literally means 'horse's tail' and is used to describe the nerve fibres at the end of the spinal cord, below the level of the second lumbar vertebra (L2).
This literally means 'horse's tail' and is used to describe the nerve fibres at the end of the spinal cord, below the level of the second lumbar vertebra (L2).
Causalgia
Disruption in normal flow of sensory information along nerve to brain, creating a confusion for the brain, which is interpreted as a constant , uniquely disabling pain state which is highly resistant tonormal forms of medical therapy.
The syndrome appears as sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes.
Disruption in normal flow of sensory information along nerve to brain, creating a confusion for the brain, which is interpreted as a constant , uniquely disabling pain state which is highly resistant tonormal forms of medical therapy.
The syndrome appears as sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes.
Cerebrospinal fluid
The clear fluid that bathes the brain and the spinal cord. It is re-moved for testing through a lumbar puncture. It is into this fluid that the radio-opaque fluid for a myelogram is injected.
The clear fluid that bathes the brain and the spinal cord. It is re-moved for testing through a lumbar puncture. It is into this fluid that the radio-opaque fluid for a myelogram is injected.
Cervical
This term describes the neck, which is made up of seven vertebrae.
This term describes the neck, which is made up of seven vertebrae.
Chemonucleolysis
This is a procedure whereby, an enzyme derived from the papaya fruit is injected into the intervertebral disc to shrink it and try and alleviate pain caused from a bulging disc.
This is a procedure whereby, an enzyme derived from the papaya fruit is injected into the intervertebral disc to shrink it and try and alleviate pain caused from a bulging disc.
Coccyx
This is the last bone of the spine that is made up of four tiny, fused vertebrae.
This is the last bone of the spine that is made up of four tiny, fused vertebrae.
Coccygodynia (Coccydynia)
Pain in the coccyx region. It can occur following a fall or other trauma. It can also be secondary to low back pain. Muscle spasm can occur in the piriformis, levator ani and coccygetis muscles.
Pain in the coccyx region. It can occur following a fall or other trauma. It can also be secondary to low back pain. Muscle spasm can occur in the piriformis, levator ani and coccygetis muscles.
Computerised Tomography (CT) Scan
Also called catscan. This is sophisticated x-ray technique for showing bone detail primarily that is performed as an outpatient procedure in the scanning unit. It is a painless procedure and takes an average of twenty minutes. Cross-sectional images are produced from information received through beams of x-rays going through the body.
Also called catscan. This is sophisticated x-ray technique for showing bone detail primarily that is performed as an outpatient procedure in the scanning unit. It is a painless procedure and takes an average of twenty minutes. Cross-sectional images are produced from information received through beams of x-rays going through the body.
Congenital
Being present at birth.
Being present at birth.
Conservative management
This describes any nonsurgical treatment of back pain e.g. physical therapies, pain killers, traction, exercises, massage.
This describes any nonsurgical treatment of back pain e.g. physical therapies, pain killers, traction, exercises, massage.
Deafferentation pain
Pain that occurs, often after trauma or surgery, presenting as neuropathic pain in an area of numbness or loss of sensation.
Pain that occurs, often after trauma or surgery, presenting as neuropathic pain in an area of numbness or loss of sensation.
Decompression
Surgical procedure for relieving pressure usually on a nerve or the spinal cord.
Surgical procedure for relieving pressure usually on a nerve or the spinal cord.
Degeneration
The process of change, usually with age, in bone or soft tissue. Sometimes referred to as 'wear and tear'.
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 the 20th to 30th year of life and by the 60th year it would be a universal finding on x-ray examination. Many people will not have any symptoms.
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 the 20th to 30th year of life and by the 60th year it would be a universal finding on x-ray examination. Many people will not have any symptoms.
Dermatome
An area of the skin that is known to be served by a specific spinal nerve.
An area of the skin that is known to be served by a specific spinal nerve.
Disc
One of the 23 shock-absorbing, pads that act as spacers of the vertebrae. Sometimes referred to as inter-vertebral disc. See annulus fibrosis, nucleus pulposus and vertebral endplates.
One of the 23 shock-absorbing, pads that act as spacers of the vertebrae. Sometimes referred to as inter-vertebral disc. See annulus fibrosis, nucleus pulposus and vertebral endplates.
Discectomy
The surgical removal of part of the disc that has prolapsed, bulged or ruptured causing pressure on spinal nerves. This operation can be done by an open method, by microsurgery or by a minimally invasive technique.
The surgical removal of part of the disc that has prolapsed, bulged or ruptured causing pressure on spinal nerves. This operation can be done by an open method, by microsurgery or by a minimally invasive technique.
Discography
An investigation that is done as an aid to a surgeon prior to surgery. A contrast medium is injected into the disc nucleus and a series of x-rays taken that will show up the structure of a disc on the discogram.
The person’s pain reaction can also help determine which disc is causing the pain.
An investigation that is done as an aid to a surgeon prior to surgery. A contrast medium is injected into the disc nucleus and a series of x-rays taken that will show up the structure of a disc on the discogram.
The person’s pain reaction can also help determine which disc is causing the pain.
Dura
The outer-most membrane surrounding the fluid that protects the spinal cord and brain.
The outer-most membrane surrounding the fluid that protects the spinal cord and brain.
Dysesthesia
Unpleasant abnormal sensations, whether spontaneous or evoked.
Unpleasant abnormal sensations, whether spontaneous or evoked.
Epidural
Epidurals are given for the relief of radicular pain. A cocktail of drugs containing a corticosteriod and a local anaesthetic is injected into the epidural space, between the bone and the membrane that encloses the spinal cord.
Epidurals are given for the relief of radicular pain. A cocktail of drugs containing a corticosteriod and a local anaesthetic is injected into the epidural space, between the bone and the membrane that encloses the spinal cord.
Facet joints
As one vertebra sits on another the top of one and the bottom of the other meet at two places referred to as the facet joints. They are synovial joints, that is they are encapsulated and produce a lubricating fluid.
As one vertebra sits on another the top of one and the bottom of the other meet at two places referred to as the facet joints. They are synovial joints, that is they are encapsulated and produce a lubricating fluid.
Fenestration
(Latin, fenestra = a window). Surgical procedure for accessing spinal nerves or a disc prolapse.
(Latin, fenestra = a window). Surgical procedure for accessing spinal nerves or a disc prolapse.
Foramen
This is the gap between the vertebrae that holds nerve roots as they emerge from the spinal cord to the left and right.
This is the gap between the vertebrae that holds nerve roots as they emerge from the spinal cord to the left and right.
Fusion
Surgical procedure designed to abolish movement across a joint. Usually involves bone grafting and sometimes metal fixation. Often takes 8 – 12 weeks to be secure.
Surgical procedure designed to abolish movement across a joint. Usually involves bone grafting and sometimes metal fixation. Often takes 8 – 12 weeks to be secure.
Gout
Gout is a type of arthritis that causes sudden and extremely painful inflammatory attacks in the joints – most commonly the big toe, ankles and knees but any other joint too. It is a common joint disease affecting over five times more men than women. It is rare in children. In men, it can occur any time after puberty, whereas in women it is uncommon before the menopause. In around 10 percent of cases there is a family history of the disorder.
Gout is a type of arthritis that causes sudden and extremely painful inflammatory attacks in the joints – most commonly the big toe, ankles and knees but any other joint too. It is a common joint disease affecting over five times more men than women. It is rare in children. In men, it can occur any time after puberty, whereas in women it is uncommon before the menopause. In around 10 percent of cases there is a family history of the disorder.
Herniation
The bulging through of a part of the body e.g. the nucleus pulposus can herniate through the annulus fibrosus.
The bulging through of a part of the body e.g. the nucleus pulposus can herniate through the annulus fibrosus.
Hyperalgesia
The perception of a painful stimulus as more painful than normal.
The perception of a painful stimulus as more painful than normal.
Instability
A term used to describe an abnormal increase in the movement of one vertebrae to another.
A term used to describe an abnormal increase in the movement of one vertebrae to another.
Kyphosis
The convex curve of the thoracic spine. It can be over exaggerated in such diseases as Osteoporosis or Scheuermann's disease.
The convex curve of the thoracic spine. It can be over exaggerated in such diseases as Osteoporosis or Scheuermann's disease.
Laminectomy
This is an operation to remove part of the bony arch at the back of a vertebra. This is done to gain access to the nerves in the foramen and allow them more space.
This is an operation to remove part of the bony arch at the back of a vertebra. This is done to gain access to the nerves in the foramen and allow them more space.
Lordosis
The concave curve found in the cervical and lumbar regions of the spine. Can be a deformity if it is excessive.
The concave curve found in the cervical and lumbar regions of the spine. Can be a deformity if it is excessive.
Ligaments
These are bands of fibrous tissue that bind a joint and control its range of movement.
These are bands of fibrous tissue that bind a joint and control its range of movement.
Lumbago
An imprecise term for low back pain.
An imprecise term for low back pain.
MRI Scan
Magnetic Resonance Imaging 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. It is a painless procedure, although like CT scans, people with claustrophobia may find it difficult. Most scanners have a panic button and radiologists will talk you through the process. Some units may have open scanners. A contrast medium (Gadolinium) can be used intravenously to gain clarity of image, especially with those who have already undergone back surgery.
Magnetic Resonance Imaging 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. It is a painless procedure, although like CT scans, people with claustrophobia may find it difficult. Most scanners have a panic button and radiologists will talk you through the process. Some units may have open scanners. A contrast medium (Gadolinium) can be used intravenously to gain clarity of image, especially with those who have already undergone back surgery.
Myelography
A water-soluble, radio-opaque dye is injected into the cerebro-spinal fluid. This allows nerve tissue to be viewed on x-ray and enables a doctor to trace any nerve entrapment. This is an invasive procedure that many people report to be unpleasant!
A water-soluble, radio-opaque dye is injected into the cerebro-spinal fluid. This allows nerve tissue to be viewed on x-ray and enables a doctor to trace any nerve entrapment. This is an invasive procedure that many people report to be unpleasant!
Nerve Root
The start of the nerve as it leaves the spinal cord or cauda equina and passes through the left and right foramen to serve an area of the body.
The start of the nerve as it leaves the spinal cord or cauda equina and passes through the left and right foramen to serve an area of the body.
Neuralgia
Pain in the distribution of a nerve or nerves.
Pain in the distribution of a nerve or nerves.
Neuropathic pain
Neuropathic pain is pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. For example pain following shingles, or an amputation, or spinal cord trauma. Pain that occurs in diabetics or in patients with multiple sclerosis. Can also be neuropathic.
Neuropathic pain is pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. For example pain following shingles, or an amputation, or spinal cord trauma. Pain that occurs in diabetics or in patients with multiple sclerosis. Can also be neuropathic.
Nociceptor
A receptor preferentially sensitive to a noxious stimulus or to stimuli that would become noxious if prolonged.
A receptor preferentially sensitive to a noxious stimulus or to stimuli that would become noxious if prolonged.
Nucleus Pulposus
The core of the intervertebral disc. It has a high fluid content in our early years and then dries out with age.
The core of the intervertebral disc. It has a high fluid content in our early years and then dries out with age.
Opioids
Opioids are a group of medicines that come from the opium poppy or are closely chemically related to it. Opioids have been used for many years for managing pain. There are many different medicines in this group and differ in the ways that they can be used and in their strengths. Some can be taken by mouth, and others are used by applying a patch to the skin. Opioids have traditionally been classified as week or strong.
Opioids are a group of medicines that come from the opium poppy or are closely chemically related to it. Opioids have been used for many years for managing pain. There are many different medicines in this group and differ in the ways that they can be used and in their strengths. Some can be taken by mouth, and others are used by applying a patch to the skin. Opioids have traditionally been classified as week or strong.
Osteoarthritis
The degenerative change of a joint, which makes it less able to withstand stresses and strains, causing pain and change to the shape of the joint.
The degenerative change of a joint, which makes it less able to withstand stresses and strains, causing pain and change to the shape of the joint.
Osteophytes
This is extra bone growth on the edges of the vertebrae which can cause narrowing of the nerve canals.
This is extra bone growth on the edges of the vertebrae which can cause narrowing of the nerve canals.
Osteoporosis
A disease of bone characterised bv the decrease of calcium content making the bone less dense. This makes the bone more liable to fracture and collapse causing spinal pain. It is more common in women after the menopause, but it can be found in people who have had eating disorders and after long-term steroid use.
A disease of bone characterised bv the decrease of calcium content making the bone less dense. This makes the bone more liable to fracture and collapse causing spinal pain. It is more common in women after the menopause, but it can be found in people who have had eating disorders and after long-term steroid use.
Pain
Pain is an emotion experienced in the brain, it is not like touch, taste, sight, smell or hearing. It is categorised into Acute pain - less than twelve weeks duration and Chronic pain - of more than twelve weeks.
Pain can be perceived as a warning of potential damage, but can also be present when no actual harm is being done to the body.
Pain is an emotion experienced in the brain, it is not like touch, taste, sight, smell or hearing. It is categorised into Acute pain - less than twelve weeks duration and Chronic pain - of more than twelve weeks.
Pain can be perceived as a warning of potential damage, but can also be present when no actual harm is being done to the body.
Paraesthesia
An abnormal sensation (such as burning, prickling formication), whether spontaneous or evoked.
An abnormal sensation (such as burning, prickling formication), whether spontaneous or evoked.
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.
Scar tissue formation around the dura. This can be as a result of natural degenerative processes or of invasive treatments, such as surgery.
Sacrum
The area of the spine between the lumbar vertebrae and the coccyx, which consists of 5 fused vertebrae.
The area of the spine between the lumbar vertebrae and the coccyx, which consists of 5 fused vertebrae.
Scheuermann's
Sometimes referred to as Spinal Osteochondritis. This is a developmental abnormality in the intervertebral discs and vertebral bodies causing them to become wedge-shaped. This can cause an increase in the kyphotic (see kyphosis) curve and predispose the person to premature wear and tear. Exercise and attention to posture and lifestyle are important to prevent pain and deformity
Sometimes referred to as Spinal Osteochondritis. This is a developmental abnormality in the intervertebral discs and vertebral bodies causing them to become wedge-shaped. This can cause an increase in the kyphotic (see kyphosis) curve and predispose the person to premature wear and tear. Exercise and attention to posture and lifestyle are important to prevent pain and deformity
Scoliosis
A sideways curvature of the spine, which can be caused by a congenital deformity or a temporary reaction caused by muscle spasm.
A sideways curvature of the spine, which can be caused by a congenital deformity or a temporary reaction caused by muscle spasm.
Sciatica
Strictly speaking it is pain along the length of the sciatic nerve that is down the back of the thigh, through the calf and into the foot. It is sometimes used more loosely to describe any leg symptoms.
Strictly speaking it is pain along the length of the sciatic nerve that is down the back of the thigh, through the calf and into the foot. It is sometimes used more loosely to describe any leg symptoms.
Spinal canal
The hole that runs the length of the spine containing the spinal cord, its covering and the nerves that leave it in pairs at each level of vertebrae.
The hole that runs the length of the spine containing the spinal cord, its covering and the nerves that leave it in pairs at each level of vertebrae.
Spinal Stenosis
Narrowing of the width of the canal causing pressure on the nerve held within it. This can occur in the central spinal canal and in the lateral (side) nerve root canals.
Narrowing of the width of the canal causing pressure on the nerve held within it. This can occur in the central spinal canal and in the lateral (side) nerve root canals.
Spondylo
A prefix meaning the vertebrae or the spinal column.
A prefix meaning the vertebrae or the spinal column.
Spondylitis
Inflammation of any of the spinal vertebrae. This can be because of injury, infection or rheumatoid disease (see Ankylosing Spondylitis).
Inflammation of any of the spinal vertebrae. This can be because of injury, infection or rheumatoid disease (see Ankylosing Spondylitis).
Spondylolisthesis
A condition where one vertebra slips out of alignment with another. Most common is the fourth over the fifth lumbar vertebra or the fifth over the sacrum. The causes can be congenital or due to structural defects,
degenerative changes and injury. Some people have it without symptoms, but others have major pain and nerve-related symptoms. Called retrolisthesis if the slippage is backwards.
A condition where one vertebra slips out of alignment with another. Most common is the fourth over the fifth lumbar vertebra or the fifth over the sacrum. The causes can be congenital or due to structural defects,
degenerative changes and injury. Some people have it without symptoms, but others have major pain and nerve-related symptoms. Called retrolisthesis if the slippage is backwards.
Spondylolysis
A crack in the neural arch of the vertebra that can predispose to a Spondvlolisthesis. This can be congenital, caused by over-use or found in people with a history of falls. Can be asymptomatic.
A crack in the neural arch of the vertebra that can predispose to a Spondvlolisthesis. This can be congenital, caused by over-use or found in people with a history of falls. Can be asymptomatic.
Spondylolysis
A condition of the spine where the discs have narrowed and osteophytes have formed at the junction of the disc and vertebra. This can lead to stiffness and eventually fixation of the joint.
A condition of the spine where the discs have narrowed and osteophytes have formed at the junction of the disc and vertebra. This can lead to stiffness and eventually fixation of the joint.
Syndrome
Term used to denote a collection of symptoms, e.g. chronic back syndrome.
Term used to denote a collection of symptoms, e.g. chronic back syndrome.
Thoracic
The region of the spine between the neck and the lumbar vertebrae. The ribs connect with the 12 thoracic vertebrae.
The region of the spine between the neck and the lumbar vertebrae. The ribs connect with the 12 thoracic vertebrae.
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.
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.
Transcutaneous Electrical Nerve Stimulation (TENS)
A battery powered machine that delivers small electric shocks via adhesively attached electrodes, placed either side of the spine with the aim of blocking the pain messages to the brain and producing the body’s natural pain killers, endorphins.
A battery powered machine that delivers small electric shocks via adhesively attached electrodes, placed either side of the spine with the aim of blocking the pain messages to the brain and producing the body’s natural pain killers, endorphins.
Vertebrae (Plural) Vertebra (Single)
The 33 bones of the spine, 24 of which are single and jointed, the others being fused.
The 33 bones of the spine, 24 of which are single and jointed, the others being fused.
Vertebral End Plates
The top and bottom of the vertebral body that comes into contact with the disc.
The top and bottom of the vertebral body that comes into contact with the disc.