Explanation of important expressions in the field of "pain"
A | B | C | D | E | F | G | H | I | L | M | N | O | P | R | S | T | U | V | W
Aciclovir Aciclovir is an analog of the nucleic base guanine, a base component of DNA and RNA. Aciclovir is used as a virostatic against herpes viruses and sold under various different trade names, such as Zovirax®. Mechanism of action: Aciclovir is phosphorylated by the viral thymidine kinase and then transformed into its active form acycloguanosine triphosphate (aciclo-GTP). If aciclo-GTP is used by the affected cell’s DNA polymerase for DNA replication in place of GTP, this will inevitably stop the DNA synthesis, since aciclo-GTP has no 3'-OH group which a following deoxynucleoside triphosphate (dNTP) could connect to. Aciclo-GTP has an affinity to viral DNA polymerase which is approximately 100 times greater than that to cellular DNA polymerase. This means that it primarily inhibits viral replication. (Source: www.wikipedia.de)
Acute (from the Latin acutus = “sharp, pointy”). In medicine, the term “acute” refers to symptoms and illnesses which break out quickly or suddenly and have a relatively short duration (3-14 days ) (as opposed to -> “chronic”).
Acute pain(nociceptive pain) Acute pain is usually short in duration and easy to localize. Acute pain arises as a warning signal in reaction to damage or danger and enables an effective protective reaction (such as pulling one’s hand away from a hot candle flame). If the cause of the pain is eliminated, the pain will usually disappear again.
A delta fibers A delta fibers are slightly myelinated, thin nerve fibers with an axon diameter of 3-5 µm and a conduction velocity of approx. 20 m/s. They are responsible for transmitting sensations of cold and painful mechanical stimuli (pinprick and pressure pain); they convey a stabbing type of pain. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Allodynia With allodynia, stimuli which would normally not cause pain (such as touch, heat and cold) are perceived as being painful. What this means in pathophysiological terms is that nonnoxic stimulus signals from low-threshold receptor cells reach nociceptive signal paths via multi-receptive (wide dynamic range, WDR) neurons in the posterior horn of the spinal cord in the scope of central sensitization. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Alpha-2-delta-subunit The alpha-2-delta subunit is a component of the voltage-dependent presynaptic calcium channels and plays an important role in controlling the opening speed of the calcium channel. The calcium ions streaming through the opened calcium channel cause excitatory neurotransmitters to be released, thus transmitting the pain signal to the synapse. The anticonvulsants gabapentin and pregabalin bind to the alpha-2-delta subunit, reduce the flow of calcium and thus suppress the transmission of pain. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Analgesic (from the Greek an- = "against" and algos = "Pain"). A pain-killing pharmaceutical. An analgesic should have the greatest pain-relieving effect possible, without impairing the awareness, sensory perception and other functions of the central nervous system (it should not have any narcotic effects).
Anamnesis Anamnesis is the systematic questioning of the patient by the physician or other person in charge of the treatment. It covers such things as the current complaints, previous illnesses, medications taken, living situation as well as previous illnesses in the family.
Anticonvulsant An anticonvulsant (also known as an antiepileptic) is a cramp-preventative or cramp-releasing substance for the symptomatic treatment of epilepsy. Depending on the substance, antiepileptics block or modulate sodium (such as carbamazepine) or calcium channels (such as gabapentin or pregabalin). In the process, they stabilize nerve cells, which are reduced in their stimulus threshold, which reduces spontaneous discharges. Some substances from the group of antiepileptics/anticonvulsants are also successfully used for neuropathic pain. Calcium channel modulators can have a positive effect on burning, shooting pains and sensitivity to touch in particular. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Anti-depressant An anti-depressive is a medication which is used to treat depression. Due to their mechanism of action (noradrenaline reuptake inhibition = NRI), certain anti-depressants have an additional pain-relieving effect and are thus also used in pain therapy to treat neuropathic pain.
Antiepileptic An antiepileptic (also known as an anticonvulsant) is a cramp-preventative or cramp-releasing substance for the symptomatic treatment of epilepsy. Depending on the substance, antiepileptics block or modulate sodium (such as carbamazepine) or calcium channels (such as gabapentin or pregabalin). In the process, they stabilize nerve cells, which are reduced in their stimulus threshold, which reduces spontaneous discharges. Some substances from the group of antiepileptics/anticonvulsants are also successfully used for neuropathic pain. Calcium channel modulators can have a positive effect on burning, shooting pains and sensitivity to touch in particular. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Antiphlogistic (from the Greek an- = “against” and phlogosis = “inflammation”). A pharmaceutical with an anti-inflammatory effect. Antiphlogistics counteract the body’s inflammation reactions, such as the expansion of the blood vessels with reddening, swelling, fever and pain.
A sudden perfusion disorder of an organ or region of the body. In today’s casual medical jargon, the term is usually used as a synonym for apoplexia cerebri (stroke), but it used to be used in connection with other organs. Causes of strokes are intracranial hemorrhages in 15% of cases and cerebral ischemia in 85% of cases (due to embolic blockages, for instance).
Autogenic training Autogenic training is a method of autosuggestion, or influencing oneself. It pursues the goal of putting oneself in a state of relaxation.
Bedside test Neuropathic pains are usually characterized by a combination of negative and positive sensory symptoms, which can be analyzed with simple “bedside” examinations (pinprick test, temperature perceptions). (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Biofeedback Biofeedback (from the Greek bios = “life” and the English “feedback”) describes a method in which usually unconscious physiological body functions are measured and made “conscious” using audio or visual signals (such as pulse or brain wave curve on the monitor). The goal is then to deliberately influence these processes.
Breakthrough pain Breakthrough pain is a temporary increase in an otherwise sufficiently treated long-term pain. It appears suddenly and usually has no discernable cause; the pain usually reaches its maximum intensity after three to five minutes. The pains last 30 minutes on the average and can appear several times a day.
Burning-feet syndrome refers to a painful burning sensation in the feet which primarily appears at night and increases during running and under heat, and can be reduced by cold. Burning-feet syndrome is characteristic of polyneuropathies. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Calcium channel modulators Calcium channel modulators include such substances as pregabalin and gabapentin. Pregabalin is approved for adults for treating peripheral and central neuropathic pain as well as for treating generalized anxiety disorders and as a supplementary treatment of focal epilepsies; it binds selectively and with great affinity to the alpha-2-delta-subunit of voltage-dependant calcium channels on nerve cell membranes and modulates the calcium flow into the nerve cell. Pregabalin does not bind to GABA (gamma-aminobutyric acid) receptors, is not metabolized into GABA or a GABA agonist and does not affect the GABA metabolism. Extensive trial data from randomized, controlled trials (approx. 10,000 patients) are available. Gabapentin’s mechanism of action has not yet been identified with any certainty, but the inhibition of glutamatergic excitation transmission is being discussed. Gabapentin does function via GABA receptors, but primarily via presynaptic calcium channels.
Cannabinoids The group of cannabinoids primarily encompasses various substances contained in the hemp plant (cannabis sativa, cannabis indica), which may vary in effect. The most heavily researched cannabinoid to date is delta-9-tetrahydrocannabinol (THC). In addition to it, cannabinoids produced naturally in the body have also been identified. They are referred to as endocannabinoids. Cannabinoids trigger their effect by binding to the cannabinoid receptors (CB1 and CB2). In addition to their psychoactive effects, cannabinoids abate pain and promote appetite, but are also associated with numerous side effects such as disorientation and tachycardia. The potential therapeutic use of cannabinoids in pain treatment is controversial, since only few credible evidence-based studies exist. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Capsaicin Capsaicin is a vegetable alkaloid which is obtained from the fruits of capsicum varieties (such as chilli peppers) and belongs to the group of capsaicinoids. Capsaicin binds to the TRP (transient receptor potential) channel of the vanilloid (TRPV1) receptor. Capsaicin causes sensations of heat and/or spiciness upon contact with the applicable receptors, such as the mucous membranes. The body reacts to the apparently painful heating with increased perfusion of the tissue in order to dissipate the heat, resulting in local reddening similar to a slight burn. Antibacterial, fungicidal and preservative effects are also ascribed to capsaicin. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Carpal tunnel syndrome
Carpal tunnel syndrome is a relatively common nerve compression syndrome which primarily affects women. The nerve which supplies the hand (N. medianus) is constricted on the inside of the wrist by connective tissue structures at the passage through the carpal tunnel. Pains frequently appear at night. Feelings of numbness and loss of grip strength characterize the clinical picture. In general, an operation initially helps to ameliorate the symptoms of pain and restore grip strength.
Cerebral infarction A cerebral infarction is usually caused by a sudden function disorder in the brain as the result of acute perfusion disorders (apoplexy). The symptoms which immediately appear depend on the area of the brain affected and comprise complete hemiplegia as well as isolated vision impairments, speech impediments or attacks of vertigo. Approximately 8% of all cerebral infarctions lead to central neuropathic pain within days to months. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Liquor cerebrospinalis (cerebrospinal fluid – CSF) is a clear and colorless bodily fluid which is connected to the tissue fluid of the brain, which it is thus very similar to in terms of composition. Cerebrospinal fluid and its communication channels were discovered by François Magendie. Cerebrospinal fluid is produced by specifically differentiated epithelial cells of the plexi of the cerebral ventricles. Normal cerebrospinal fluid is as clear and colorless as water and contains very few cells. Most of them are lymphocytes (up to 3 per of µl cerebrospinal fluid); monocytes are rare. The lymphocytes are predominately T lymphocytes, only about 1% of the lymphocytes in the cerebrospinal fluid are B lymphocytes (in contrast, the proportion of B-lymphocytes in all lymphocytes in the blood is approximately 5-10%). The protein content is approximately 0.15 to 0.45 grams per liter of cerebrospinal fluid. The normal glucose content amounts to 50 to 70% of the serum blood glucose value.
C-fibers C-fibers are unmyelinated, thin nerve fibers with an axon diameter of approx. 1 µm and a conduction velocity of approx. 2 m/s. They are responsible for transmitting sensations of heat and painful mechanical stimuli (pressure pain); the pain they convey is drilling, burning and dull in character.
Chemotherapy-induced neuropathic pain Certain substances which are used in chemotherapy for cancer cause damage to individual (mononeuropathy) or multiple (polyneuropathy) nerves. The clinical symptoms correspond to those of polyneuropathies, such as numbness, tingling or pains in the hands and feet on both sides. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Chronic (from the Greek chronos = “time”). In medical terminology, “chronic” refers to complaints or illnesses which develop slowly or persist for long periods of time (as opposed to -> “acute”).
Chronification The transition from acute complaints, especially pain, to a chronic phenomenon is referred to as chronification. Chronification is at hand when an illness or symptoms, especially pain, persist for long periods of time (more than three to six months). This is usually due to improper processing in the brain.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is the chronic form of Guillain-Barré syndrome (the most common severe paralytic disease of the peripheral nervous symptom, with a mortality of up to 8% and permanent disability in nearly half of all patients). The immunologically triggered inflammatory reaction appears after an immune disorder and leads to a demyelinating chronic polyneuropathy. Treatment is conducted symptomatically and makes use of corticosteroids, immunoglobulins and immunosuppressants as well as analgesic therapy with antiphlogistics and antiepileptics. The prognosis of CIDP is variable and ranges from good chances of healing or regression to slight defects all the way to lethal progressions. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Coccydynia Coccydynia refers to chronic pain in the coccyx or tailbone area (os coccygis). Women are more frequently affected by it than men are. The cause of coccydynia remains unexplained in many cases.
Comorbidity Comorbidity denotes a diagnostically definable disease or disorder which appears in addition to an underlying disease, to which it may (but need not necessarily) be causally connected in the sense of a secondary complication. Psychological phenomena such as fear, depression and pain-related sleep disorders are frequently noted as a comorbidity with chronic pain afflictions.
Compliance In medical terminology, compliance (also known as adherence) describes the degree to which a patient observes and follows an agreed treatment.
Computer tomography (CT) Computer tomography (from the Greek tome = “section” and graphein, “to write”) is a special X-ray imaging method which creates cross sections of the body regions examined using a great number of X-ray images. This makes it possible to assess nearly all body regions and structures. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Complex regional pain syndrome (CRPS) is a neurological affliction with a pathogenesis which has not yet been conclusively clarified. Terms such as Morbus Sudeck or sympathetic reflex dystrophy are used as synonyms for it. An irregular healing process after a distal injury to the extremities is characteristic of the ailment. The severity of the injury is of no importance – it may even be so slight that the patient does not remember it. The injury leads to improper regulation of the sympathetic nervous system. Clinical symptoms of CRPS include:
- typical neuropathic pain symptomatology,
- the pain is frequently nociceptive in nature as well,
- distal characteristics,
- autonomous and trophic malfunctions with localized differences in skin temperature,
- swelling of the extremities,
- deficits in motor function,
- sweat secretion disorders,
(Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
- Sudeck; Morbus Sudeck; reflex dystrophy; RSD
This form of pain arises when peripheral nerves or nerve roots are severed, e.g. by an accident, operation or amputation. The latter case is referred to as stump or phantom pain, in which the affected person perceives pain in the amputated limb which is no longer there. This dysesthesia can have many different causes. For instance, an “image” of the amputated (or no longer afferently innervated) limb in the cortex as well as memory of the pain for precisely the location which used to hurt, play a role. Stump pain occurs in the part of the limb which remains attached to the body. Neuromas (a growth or tumor of nerve tissue) which are very sensitive to touch, changes in weather and heat form at the nerve stumps.
Degenerative In medicine, “degeneration” refers to the regression and deterioration of tissues or organs, due to such causes as chronic damage or age-related processes.
Depression In common speech, “depression” refers to a state of psychological despondence which is characterized by symptoms such as low spirits, loss of interest, joylessness and lack of energy. In the medical sense of the word, “depression” describes an affective disorder which is treated with antidepressants and/or psychotherapy (such as depth-oriented psychological or behavioural therapeutic methods), depending on its severity and progression.
Diabetic polyneuropathy is a complication of diabetes mellitus and (depending on the quality of metabolic management) appears in more than half of all diabetics after an illness duration of approx. 10 years. The precise cause is not yet fully understood. Its background is believed to be damage to the blood vessels supplying the nerves. Initial complaints are frequently a tingling in the extremities. Paresthesia and feelings of numbness follow, especially at rest. Severe neuropathic pain, especially in the legs and feet, may appear in the subsequent progression. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
(also known as nucleotomy, discotomy) Discectomy is a less invasive microsurgical procedure for operating on or removing a prolapsed intervertebral disc. The intervertebral disc is removed using alligator forceps with a suction device under endoscopic view. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Disease model, biopsychosocial "The biopsychosocial disease model interprets pain as an overall psychophysical phenomenon (in contrast to the traditional understanding of pain). Here, pain serves as a direct expression of organic damage, the intensity of which is proportional to the degree of damage. In addition to physical components, behavioural, cognitive and affective components are also involved in the onset and perpetuation of pain. With chronic pain syndromes, the factors which cause and/or perpetuate the pain are divided into biological, psychological and social aspects which heavily interact with one another. The identification and weighting of these factors provide important information for treatment. The most important diagnostic procedure is the biographical medical history. It inquires about the influencing factors which have disposing, triggering and stabilizing effects on the pain, as well as about the degree of impairment, the patient’s own coping strategies and explanation models, the function which the symptom of pain has in the social system and about how important attachment figures and relationship partners handle it and affect the patient’s interaction behavior.
Dysesthesia Dysesthesia (from the Greek dys = ""abnormal"" and aisthesis = ""sensation"") refers to an unpleasant or painful abnormal sensation. Dysesthesia frequently appears in connection with polyneuropathy. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Electromyography (EMG) Electromyography (EMG) measures the naturally occurring electrical voltage in a muscle. The method primarily serves to determine whether a muscle affliction or a conduction disturbance of the nerve supplying the muscle is present.
Electroneurography (ENG) + Electroneurography (ENG) is a method which measures the nerve conduction velocity of a nerve which is artificially stimulated by electrodes. It is used for such purposes as diagnosing a conduction disturbance in a peripheral nerve.
Electrostimulation refers to the stimulation of nerve sections using electrodes. The various procedures include spinal cord stimulation (SCS), in which the electrodes are implanted in the epidural space in the area of the funiculus posterior, as well as peripheral nerve stimulation and transcutaneous nerve stimulation (TENS), in which the proximal nerve sections are stimulated using surface electrodes. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Endorphins Endorphins are opioids produced by the body itself. The so-called “happiness hormones” abate and/or suppress pain.
Entrapment syndrome Entrapment syndrome (impingement syndrome) consists of a peripheral focal painful neuropathy caused by a pinched nerve or change in the nerve structure by other tissues. Causes may include tissue swelling caused by edemas, compressed ligaments, calcifications on tendons, anatomical variants and the results of broken bones (such as carpal tunnel syndrome, tarsal tunnel syndrome). (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Evoked pain Evoked pain is triggered by the application of external stimulus and comprises various forms of mechanical and thermal hyperalgesia and/or allodynia. Evoked pain is typical of neuropathic pain. Diagnostics is usually possible using simple clinical testing methods (bedside tests). (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Failed back surgery syndrome (FBSS) Failed back surgery syndrome (FBSS) is characterized by persistent pain symptoms (mixed pain) in the area of the back after an operation on the spinal column. It may also be accompanied by neurological deficits in some cases. Frequent causes of FBSS are repeated slipped discs or scar formation in the operation area. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Fibromyalgia Fibromyalgia is a chronic, non-inflammatory affliction which is characterized by pain in the area of the tendons, fascia and muscles. The exact mechanism that causes it is not yet clear. Disorders in pain regulation loops in the brain and central pain and stress processing as well as a suspension of decreasing inhibition are being discussed as potential causes. A marked increase in the substance P with a simultaneous reduction in the transmitter serotonin can be detected. It is unclear whether these changes are the cause of fibromyalgia or a result of psychosomatic influences. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
GABA Gamma-aminobutyric acid (GABA) serves as a neurotransmitter for transmitting information between the neurons of the central nervous system and is the most important transmitter of the suppressive synapses. The effect is conveyed by binding to GABAA (chloride channels) and GABAB receptors (calcium and potassium channels). (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Herpes zoster Herpes zoster (commonly known as shingles) is an affliction triggered by the varicella zoster virus, which is usually accompanied by a painful, stripe-shaped skin rash with blisters on one side of the body. It is caused by the reactivation of varicella zoster viruses (the pathogen that causes chickenpox) which persist in the sensory ganglia after a primary chickenpox infection.
Hypalgesia Hypalgesia denotes a decreased sensitivity to painful noxic stimuli. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Hyperalgesia Hyperalgesia is an increased sensitivity to pain under the effect of painful noxic stimuli. Stimuli which a healthy subject perceives to be painful is perceived as being excessively intense by patients with neuropathic pain. Hyperalgesia is usually caused by sensitization of the nociceptors. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Hypoesthesia Hypoesthesia refers to a reduced sense of touch or sensation of the skin and mucous membranes. Hypoesthesia is caused by a lesion in the nervous system. It can be accompanied by motor function disorders in the innervations area. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Idiopathic Idiopathic means without a recognizable cause.
An inflammation (the Latin medical term being “Inflammatio”) is a characteristic response of biological tissue to an externally or internally triggered stimulus with the function of eliminating the harmful stimulus, preventing it from spreading and repairing any damage which may have occurred. An inflammation can manifest itself in a defined area or as a systemic inflammation reaction. The five symptoms of inflammation:
- Reddening = Latin: Rubor
- Hyperthermia = Latin: Calor
- Swelling = Latin: Tumor
- Pain = Latin: Dolor
- Restricted function = Latin: Functio laesa
Cave: These five symptoms are not always immediately recognizable or may only be partially detectable. An inflammation of the gastric mucosa, for instance, primarily causes pain after meals, but is usually denoted by massive nausea.
Interneurons Interneurons are GABA neurons which physiologically have an inhibiting effect on the neurons of the posterior horn and are thus involved in regulating the perception of pain. In cases of chronic pain, these neurons can lose their function, which aids the transmission of pain and central sensitization. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Interventional treatment methods Interventional pain treatment methods enable the targeted treatment of the affected regions of the body; they are used for such purposes as the acute treatment of pain exacerbation or as a stop-gap until the effect of treatment with medication takes hold. The methods include nerve blockages with local anesthetics (plexus, neuraxial, sympathetic nervous system) or opioids (ganglionic local opioid application [GLOA], neuraxial). (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Intervertebral disc An intervertebral disc (Latin: fiscus intervertebralis) is a flexible, fibrocartilaginous connection (synarthrosis) between two vertebral bodies. The human spine has 23 intervertebral discs; there are no intervertebral discs between the skull and the first cervical vertebra (atlas) as well as between the first and second cervical vertebra (axis). The intervertebral discs make up about 25 percent of the overall length of the spinal column. Intervertebral discs are made up of two parts: the external anulus fibrosus (fiber ring) and the internal nucleus pulposus (gelatinous core). The anulus fibrosus is made up of concentric layers of collagen connective tissue fibers (outer zone), which gradually transition into fibrocartilage (inner zone). The connective tissue fibers affix themselves to the vertebral bodies. The nucleus pulposus is a gelatinous tissue with a high water content and a low number of cells. It absorbs impact like a water cushion. If its fluid escapes through the anulus fibrosus as the result of damage, then it is referred to as a prolapse of the nucleus pulposus or herniated vertebral disc. The intervertebral discs contain fluid. The discs lose this fluid if pressure is placed upon them. This can cause a person to shrink by up to three centimeters per day. The intervertebral discs reabsorb the fluid like a sponge when relaxed in a lying position, i.e. during sleep. This pressing and absorption is also the only way the intervertebral discs are supplied with nutrients, since they no longer have any blood vessels after the age of 20 once growth is complete. The change in pressure between strain and relaxation is thus a prerequisite for the intervertebral discs’ metabolism.
Intervertebral disc prolapse
The slipped disc (Latin prolapsus nuclei pulposi, also known as slipped disc) is an affliction of the spinal column in which portions of the intervertebral disc protrude into the vertebral canal (the space where the spinal column is located). In contrast to a protrusion (bulging) of the intervertebral disc, a prolapse means that the fibrocartilaginous ring of the intervertebral disc (anulus fibrosus) is entirely or partially torn, while the posterior longitudinal ligament may remain intact (known as a subligamentous disc herniation). It is frequently caused by overloading when one has a previous intervertebral disc injury, but an intervertebral disc prolapse can also appear without external provocation. Symptoms of an intervertebral disc prolapse are intense pains which frequently radiate into the extremities. They are often accompanied by numbness in the supply area of the pinched nerve root as well as symptoms of paralysis in some cases. Conservative treatment is possible in most cases, although severe prolapses must be operated on.
Intervertebral disc protrusion The intervertebral disc protrusion (also known as a bulging disc or “incomplete prolapsed disc”) is a degenerative change in the intervertebral discs. Here, the disc’s anulus fibrosus (fiber ring) is not torn through, but only bulges outwards. A protrusion usually only results in painful symptoms in the spinal column area, but in rarer cases can lead to a complete intervertebral disc syndrome. Treatment is generally conservative, but an operation is occasionally required as well.
Ischemic neuropathy Ischemic neuropathy is a non-inflammatory nervous disease which is caused by a reduction or complete prevention of the local arterial blood supply, for instance in the case of peripheral artery occlusive disease (PAOD). It belongs to the category of peripheral focal neuropathies. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Ischemic pain The most common cause of ischemic pain is a peripheral arterial perfusion disorder. Pains in muscle groups distal to the vascular obliteration are typical, predominately under strain. (Source: Baron et al., Glossar Neuropathischer Schmerz [“Glossary of Neuropathic Pain”], 2007; AESOPUS Verlag e.V., Linkenheim-Hochstetten)
Ischialgia Ischialgia refers to pains in the supply area of the nervus ischiadicus which are caused by compression of the nerve roots, for instance by the bulging of a intervertebral disc (protrusion) or the complete escape of the gelatinous core of the intervertebral disc (prolapse).
LOCF (Last observation carried forward) The LOCF method (last observation carried forward) is frequently applied in clinical trials during longitudinal studies (the examination of processes of change). In it, values missing for each patient are replaced by the last measured value. If a patient leaves the trial, the last value measured for him or her will be carried forward until the end of the trial.
Lumbago/lower back pain
Lumbago is an acute or chronic lumbar spine pain syndrome without radiation into the lower extremities. With the acute form of progression, the pain appears within a day for either the first time or after a symptom-free period of at least six months and persists for a maximum of three months. With a chronic progression, the pain symptoms last for longer than three months. A sudden, initially segmental, shooting pain in the back which is triggered by stimulation of the sensitive innervation of the spinal column is typical. It is frequently associated with constrained posture, restricted motion, myogelosis, spinous process pressure pain, etc. Chronification is possible.
- sacroiliac pain
- lower back pain
- lumbar spine pain syndrome
Lumbar spine syndrome
Lumbar spine syndrome is an umbrella term for degenerative changes or static-muscular disorders in the area of the lumbar spine which primarily manifest themselves in the form of lower back pains (lumbago). The simultaneous presence of nerve root compression typically results in the radiation of pain to the corresponding radicular dermatome, i.e. lumboischialgia.
- lower pack pains
Lumboischialgia Lumboischialgia is lumbar spine pain syndrome with radiation of pain into the lower extremities which is caused by compression of the nerve root. There may also be motor and/or sensory deficits in the dermatome of the affected nerve root. Lumboischialgia is frequently the result of a slipped disc, which is usually localized between lumbar vertebral body 4 and 5 or between lumbar vertebral body 5 and sacral vertebral body 1. Space-taking processes caused by other pathological changes such as osteophytes or hypertrophy of the facet joints may also be present.
Lymphocytes are cellular components of the blood. They consist of B cells, T cells and the natural killer cells and belong to the so-called ""white blood cells"" (leukocytes). In adults, approximately 25-40% of the leukocytes in the peripheral blood are lymphocytes.
- B cells, T cells, killer cells, leukocytes
Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) is an imaging method to depict the structure and function of organs and tissues. MRI uses magnetic fields and radio waves to generate cross sections of the regions to be examined.
Mechanism-oriented therapy Pains can be differentiated not only by the causes, but also by the mechanisms which are involved in the onset of the pain. For that reason, pain therapists adapt their treatment not only to the intensity of the pain, but above all according to the pain mechanisms as well.
Mixed pain Mixed pain refers to a pain syndrome which has both nociceptive and neuropathic components, i.e. a syndrome in which different pathomechanisms coexist. Mixed pain is frequently present with chronic back pains (back pain with a neuropathic component), tumor pains or complex regional pain syndrome (CRPS).
MOR Abbreviation for µ ("mu") opioid receptor. MOR agonists are substances which link to the µ opioid receptor and thus have a pain-relieving effect.
MOR-NRI A new substance class (centrally acting analgesics) which was proposed by an international group of pharmacologists. Both µ-opioid receptors and noradrenaline reuptake inhibition are activated by way of a synergistic mechanism of action. Tapentadol is the first representative of this new class. (Kress, H. Eur. J. Pain 2010, 781-783)
Morphine Morphine is one of the opiates or strong opioids. In medicine, it is used for severe pain.
Multimodal pain therapy Multimodal pain therapy is an interdisciplinary treatment method. A prerequisite is the participation of at least two medical disciplines with collective therapy planning and regular team meetings. Several other forms of therapy must also be used in addition to pharmacotherapy and interventional therapy approaches (such as psychotherapy special physiotherapy, ergotherapy, sensomotoric training, relaxation methods). Indications include such examples as the failure of at least one unimodal therapy, persistent impairment of the quality of life and/or inability to work, dependency on medications as well as other severe somatic or psychological comorbidities.
Multiple sclerosis (MS, also known as encephalomyelitis disseminata) is an inflammatory disease of the central nervous system which usually progresses in flare-ups. MS leads to focal demyelination and damage to the axons. The type of symptoms (such as impaired vision, spastic paralysis and coordination disorders) depend on the location of the damage. After epilepsy, multiple sclerosis is the second most common neurological disease in young adults. Central neuropathic pain appears in 20% of the patients (pain syndrome, central).
- encephalomyelitis disseminata
Muscle relaxants Muscle relaxants are pharmaceuticals which induce a temporary relaxation of the skeletal musculature.
Narcotic In legal terms, “narcotics” refer to substances or preparations which are listed in Annexes I to III of the German Narcotics Act (Betäubungsmittelgesetz – BtMG). These can be illegal drugs such as heroin, cocaine or cannabis as well as substances with medical uses such as opiates/opioids or barbiturates. The medical administration of narcotics is governed by the Regulation on the Prescription of Narcotics (Betäubungsmittelverschreibungs-Verordnung - BtMVV).
Neuralgia (""nerve pain"") denotes a pain in the innervations area of a nerve or nerve root as the result of pathological changes to the affected nerve. Neuralgias are chronic pain afflictions which usually manifest themselves in attack-like encompassing pain and strict localization on one side. The most widely known forms include trigeminal neuralgia, post-zosteric neuralgia and ischialgia. Neuralgia can be caused by nerve damage from compression, degenerative inflammatory processes as well as infectious processes.
- trigeminal neuralgia
- post-zosteric neuralgia
Neuritis Neuritis is the inflammation of peripheral or cranial nerves.
Neurodestructive procedures Neurodestructive procedures are used to damage nerves with chemical or thermal noxes, thus preventing pain from being conveyed. Due to the risk of deafferentation pain developing, neurodestructive procedures are only used as the last resort in the event of reduced lifespan. Chemical neurolyses in the sympathetic nervous system with ischemic pain and visceral tumor pains (plexus coeliacus) remain indicated. Thermocoagulation and cryotherapy are very time-consuming and often only yield slight benefits.
Neuromodulation comprises reversible procedures to influence the neuronal transmission of afferent and efferent fibers, such as electrostimulation procedures and continuous application of medication using pump systems in the central or peripheral nervous system. Invasive neuromodulation procedures include implantable infusion pumps (intrathecal pharmacotherapy), spinal cord stimulation (SCS), deep brain stimulation (DBS), radiofrequency therapy (RF) as well as peripheral nerve stimulation. The non-invasive procedures include transcutaneous electrical nerve stimulation (TENS). Due to the potential complications and expenses involved, the invasive procedures are not the first choice of treatment and require the extremely careful determination of an indication.
- spinal cord stimulation
- radiofrequency therapy
- peripheral nerve stimulation
Neuropathy Neuropathy is a collective term for various disorders of the peripheral nervous system. Damage to a single peripheral nerve is known as mononeuropathy, while damage to multiple nerves is known as polyneuropathy. Neuropathy can manifest itself in different ways and may be accompanied by predominate damage to motor, sensory or autonomic nerve fibers as well as mixed forms. Primary (hereditary) polyneuropathies are rare. Secondary forms due to other illnesses (such as diabetes mellitus or Fabry's disease) or neurotoxic substances (such as alcohol) are common in western industrialized nations. Neuropathies may be causes for neuropathic pains.
Neuropathic pains Neuropathic pains are caused by damage to the peripheral and/or central nervous system and are distinguished from nociceptive pains by pathophysiological, diagnostic and therapeutic factors. A great number of positive (characteristic forms of pain, tingling sensations) and negative sensory symptoms (reduced perceptions of mechanical and/or thermal stimuli) can be detected with neuropathic pains. A triad of burning spontaneous pains, shooting pain attacks and evoked pains can often be observed.
Neuroplasticity Even brief nociceptive stimulation can trigger functional and structural changes in individual nerve cells and synaptic transmission (synaptic plasticity) as well as in cerebral areas (cortical plasticity). After a certain point in time, this reinforces the transmission of the signal. The phenomena of central sensitization may be maintained by the structural changes (pain memory) in the further progression. Neuroplasticity appears to promote the development of a chronic pain disorder. The therapeutic consequence is to prevent the signal cascade from being initiated by nociceptive stimuli and commence pain therapy early on (pre-emptive use of analgesics and/or conduction blockades).
Nociceptors Nociceptors are receptors which register painful stimuli and thus warn of impending or emerging tissue damage. Nociceptors are present in nearly all organs. The excitement of nociceptors by a variety of mechanical, chemical and thermal tissue-damaging stimuli is transmitted to the nervous system, which causes pain to be perceived.
Nociceptive pains Nociceptive pains are caused by the excitement of nociceptors and transmission by intact peripheral and central nociceptive structures. Acute nociceptive pains appear as a warning symptom before impending or emerging tissue damage. Chronic nociceptive pains frequently appear in the scope of arthrosis and arthritis.
Non-opioid analgesics together with opioid analgesics form the group of classic pain relievers. Non-opioid analgesics are divided into two groups:
- Non-steroidal antirheumatics (NSAR): Substances which possess a pronounced NSAR antiphlogistic effect in addition to an NSAR analgesic and antipyretic effect.
- Non-acidic antipyretic analgesics: Substances which do not have an anti-inflammatory effect at therapeutic doses.
- Non-steroidal anti-rheumatics (NSAR)
- Non-acidic antipyretic analgesics"
NRI NRI (noradrenaline reuptake inhibition) refers to the inhibition of the reuptake of noradrenaline in the presynaptic nerve endings. This increases the noradrenaline in the synaptic gap and produces a pain-relieving effect, among other things.
The numeric rating scale (NRS) is a self-assessment scale to evaluate pain and/or pain intensity. The patient ranks his or her pain on a scale of 0 to 10 (0 = no pain, 10 = the greatest pain imaginable). The NRS serves to document a disease or course of treatment as well as to standardize pain phenomena
NSAR (non-steroidal anti-rheumatics)
Non-steroidal anti-rheumatics also known as non-steroidal anti-inflammatory drugs, NSAID): Substances which possess a pronounced antiphlogistic (anti-inflammatory) effect in addition to an analgesic and antipyretic (fever lowering) effect. Non-acidic antipyretic analgesics: Substances which do not have an anti-inflammatory effect at therapeutic doses.
- Non-steroidal anti-rheumatics (NSAR)
- Non-acidic antipyretic analgesics
Obstipation Constipation, impaired action of the bowels.
Opioids All substances or pain relievers which possess a morphine-like effect are called opioids. There are opioids which are produced naturally by the body (such as endorphins) which play a role in suppressing pain during stress reactions. Both synthetic and semi-synthetic opioids are used therapeutically (opioid analgesics).
Opioid analgesics refer to centrally acting analgesics which are very similar in effect to morphine. Opioid analgesics function as ligands on opioid receptors, which are most frequently found in the brain and spinal cord, as well as in the periphery (such as in the intestines). According to the WHO classification scheme, class III opioids such as buprenorphine, oxycodone, hydromorphone, fentanyl, methadone, etc. are subject to the Regulation on the Prescription of Narcotics (Betäubungsmittelverschreibungs-Verordnung - BtMVV). Opioid analgesics form the group of classic pain relievers together with non-opioid analgesics.
- oxycodone, hydromorphone, fentanyl, methadone
Oral The oral administration of a medication refers to its intake through the mouth and absorption via the gastrointestinal tract.
The painDetect questionnaire is a screening instrument for identifying and differentiating the primary component of the pain (neuropathic versus nociceptive). The pain questionnaire was validated at selected pain treatment centers. Its sensitivity and specificity for detecting neuropathic pain components is over 80%. In the painDetect questionnaire, the patients indicate the intensity of the pain and the pain pattern and answer seven questions about the quality of the pain. A clinical examination is not required for this screening, but must be conducted subsequently in order to make a detailed diagnosis.
Pain memory When nerve cells are exposed to pain impulses again and again over a long period of time, they change their activity. They become over-sensitive, meaning that a slight stimulus, such as touch or warmth, will suffice to be transmitted to the brain as an unpleasant painful sensation. Processes like those in the formation of memory play out on a cellular and molecular level. This pain memory plays an important role in the chronification of pain.
Pain threshold Pain threshold refers to the intensity or duration of a stimulus at which it begins to be perceived as being painful.
Pain tolerance Pain tolerance refers to the degree of pain which a person can bear.
Paralysis refers to a complete incapacitation of the musculature. It can affect individual muscles as well as the entire musculature.
Paresis Paresis (Greek Πάρεσις, páresis = “flagging, letting go”) is synonymous with paralysis. However, the word is frequently used in the restrictive sense of “incomplete loss of strength”. Complete incapacitation, on the other hand, is referred to as paralysis or plegia, while a sensory incapacitation (numbness) is referred to as a sensitivity disorder. Paresis is usually caused by neurological disorders, such as the initial motor neuron which runs from the brain to the spinal cord, where it is redirected.
Paresthesia refers to a non-painful sensory disorder which may appear in the event of metabolic disorders (such as diabetes mellitus) and nerve supply disorders. Paresthesia usually manifests itself as tingling sensations (pins and needles) or feelings of numbness. Paresthesia also appears in the event of acute poisoning, alcoholism or medication side-effects.
Peripheral nerve stimulation (PNS)
Peripheral nerve stimulation (PNS) is an invasive neuromodulation procedure to treat chronic, burning pain after peripheral, incomplete nerve damage in connection with allodynia and hyperalgesia (for instance, in the event of CRPS or mononeuropathy). With PNS, an operation is conducted to expose the peripheral nerve proximal to the lesion over an approx. 2 cm long stretch. Microsurgery is used to affix a usually four-pole electrode epineurally in the area of the nerve and divert it externally after subcutaneous tunneling, in order to be able to conduct test simulations (as with spinal cord electro-stimulation). This results in selective stimulatory paresthesia affecting the nerve in question. If a test stimulation of up to four weeks indicates a significant and reproducible reduction in pain, the impulse generator will be connected to the electrode and implanted as well. This method’s significant value cannot yet be evaluated based on evidence.
Phantom pain Phantom pain refers to the perception of pain in a body part which is no longer there (i.e. after an amputation). Its frequency after amputations is placed at up to 80% (primarily after amputations of the extremities, but also after the loss of teeth, breasts, rectum, etc.). Phantom pains are frequently shooting or cramp-like in nature and can be triggered by stimuli to the stump, or in some cases the face or the entire side of the body. Phenomena such as ""telescoping"" or ""teleshrinking"" (perception of an altered length of the phantom limb) as well as occasional spontaneous and painful imaginary ""movements"" of the phantom limb which are perceived to be real may occur in the scope of phantom pains. Phantom pain is distinguished from stump pain.
Plasma half-life, also known as elimination half-life, refers to the period of time over which the maximum concentration of a pharmaceutical in the blood plasma declines to half of that value. This parameter is an important core variable in pharmacokinetics and is frequently specified using the symbol t1/2.
- t1/2; half-life; elimination half-line
Pleocytosis Pleocytosis is an increase in cell count in the medium in question. It frequently refers to pleocytosis in the cerebrospinal fluid. Its criterion according to Samson is a cell concentration of at least 12 /3 cells per mm³ in the cerebrospinal fluid according to histological counts in the Fuchs-Rosenthal chamber. Normal values are 1 to 2 /3 cells in the ventricle, 0 to 4 /3 in the cistern and 3 to 8 /3 lumbal. In the event of acute inflammatory processes (such as those caused by bacteria), there is an increased number of granulocytes, while the number of lymphocytes generally increases in the case of viruses (such as varicella zoster viruses) and mycoses and chronic processes. Eosinophil granulocytes appear in the event of parasitic infections.
Polyneurophathy A disorder of the nervous system in which multiple nerves are impaired. Diabetes mellitus is one of the most common causes of polyneuropathy (diabetic polyneuropathy).
Post-discectomy syndrome (post-nucleotomy syndrome) refers to a pain condition after a discectomy which is difficult to treat. The syndrome can be accompanied by pseudoradicular or radicular symptoms. Usually, a back pain which already appeared before the operation remains with radiation into the leg; in some cases, the pains are even intensified after a phase of abatement. There commonly is an association with pain in the groin and/or leg; pain on bending forward is less common. The post-laminectomy syndrome shows almost identical symptoms. Persisting pain conditions are now collectively referred to as failed back surgery syndrome (FBSS), which constitutes the classic example of mixed pain (e.g. lumboischialgia).
- post-nucleotomy syndrome, mixed pain, lumboischialgia
Postherpetic neuralgia refers to nerve pain which appears after an infection with herpes zoster viruses and persists for weeks or even months, even though the disease has healed.
- postzosteric neuralgia; post-zoster neuralgia
Postzosteric neuralgia Chronified pain after shingles (herpes zoster), which are caused by what are known as varicella zoster viruses (group of herpes viruses).
Prescription for narcotics A prescription for narcotics is a special official form which the physician uses to prescribe narcotics (such as opioids) to patients.
Radiculopathy or radiculitis (Latin radicula = “little root” and Greek Ραδιοκuλο , -πατηια = “disease” or -ιτισ , -itis, = “-inflammation”), root neuritis or root syndrome refer to irritation or damage to the nerve roots. It can manifest itself in sensory disorders, pain or paralysis and can have an acute or chronic progression.
- root neuritis; root syndrome
Rheumatism The name is derived from the Greek rheo (“I flow”) and refers to afflictions of the musculoskeletal system with flowing, tearing and dragging pains. A great many disorders, some of which are very different from one another, fall under the category of rheumatic diseases.
SMP (sympathically maintained pain) Sympathically maintained pain (SMP) is a synonym for various neuropathic pain syndromes (such as CRPS), in which the coupling of sympathetic efferents and C-fiber afferents cause pain. Spontaneous pains and evoked pans (pains caused by external stimulation) are typical. In the case of SMP, pain can be relieved by interrupting the efferent sympathetic innervations to the symptomatic body part.
Sustained-release preparation In medical terminology, sustained means “with a delayed action or release”. Sustained-release preparations are pharmaceuticals in a special form (capsules, pellets), which release their active ingredient gradually instead of all at once.
Synergism A synergy arises from the parallel effect of various aligned forces which become stronger when combined, so that the value of the whole is more than the sum of its parts.
TENS (transcutaneous electrical nerve stimulation) TENS (transcutaneous electrical nerve stimulation) is a procedure of electrical stimulation or neuromodulation. With TENS, electrical impulses are transmitted to the skin surface in the vicinity of painful regions using surface electrodes. The goal is to influence the afferent transmission of pain.
Ultrasound (sonography) Ultrasound is an imaging procedure which is based on different physical properties (such as absorption, scattering and reflection) of sound waves in different tissues.
Varicella zoster virus
Varicella zoster virus (VCV) is a DNA virus from the group of the eight herpes viruses which can cause diseases in humans and other vertebrates. The VC virus causes chickenpox and shingles. It is transmitted via airborne infection.
- herpes virus; human herpes virus 3
VAS scale (visual analogue scale) A visual analogue scale (VAS) is used to measure the patient’s subjective feelings. The patient has to rate his or her sensations on a scale from 0 (= no sensation) to 100 (= the strongest sensation imaginable). Regular documentation provides an overview of a treatment's success and progression over time.
Viruses (from the Latin for ""poison, juice, slime"") are intracellular parasites in the cells of living organisms which are not cellular themselves. Viruses contain the program (some viruses also contain other auxiliary components) for their multiplication and spreading, but do not possess a metabolism of their own and thus depend on the metabolism of the host cell. They are thus intracellular parasites. Viruses infest the cells of eukaryotes (plants, animals, humans, fungi) and prokaryotes (bacteria and archaea). Viruses which use prokaryotes as hosts are known as bacteriophages. The study of viruses is known as virology.
WHO pain ladder The WHO pain ladder is a diagram from the World Health Organization (WHO) on the use of pain medications and other pharmaceuticals in the scope of pain treatment. It was originally developed for tumor pains. The individual pain relievers were assigned to different levels of pain treatment depending on the severity of the pain. The system is obsolete today and no longer meets the requirements of modern pain treatment, since it does not sufficiently take the onset mechanism of the pains into account.
24 Apr 2015