Definitions & Glossary
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.
A painful, inflammatory disease of unknown origin that causes
the sacroiliac joints and spinal vertebrae to fuse (ankylose)
The tough, fibrous outer casing of the intervertebral disc
that holds the nucleus pulposus in place.
Another name for the facet joint.
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.
On both sides of the bodv.
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.
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.
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)
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
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
This term describes the neck, which is made up of seven vertebrae.
This is a procedure whereby, an enzyme derived from the papaya
fruit is infected into the intervertebral disc to shrink it
and try and alleviate pain caused from a bulging disc.
This is the last bone of the spine that is made up of four
tiny, fused vertebrae.
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
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.
Being present at birth.
This describes any nonsurgical treatment of back pain e.g.
physical therapies, pain killers, traction, exercises, massage.
Pain that occurs, often after trauma or surgery, presenting
as neuropathic pain in an area of numbness or loss of sensation.
Surgical procedure for relieving pressure usually on a nerve
or the spinal cord.
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.
An area of the skin that is known to be served by a specific
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.
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.
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.
The outer-most membrane surrounding the fluid that protects
the spinal cord and brain.
Unpleasant abnormal sensations, whether spontaneous or evoked.
Epidurals are given for the relief of leg 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.
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.
(Latin, fenestra = a window). Surgical procedure for accessing
spinal nerves or a disc prolapse.
This is the gap between the vertebrae that holds nerve roots
as they emerge from the spinal cord to the left and right.
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 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.
The bulging through of a part of the body e.g. the nucleus
pulposus can herniate through the annulus fibrosus.
The perception of a painful stimulus as more painful than
A term used to describe an abnormal increase in the movement
of one vertebrae to another.
The convex curve of the thoracic spine. It can be over exaggerated
in such diseases as Osteoporosis or Scheuermann's disease.
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.
The concave curve found in the cervical and lumbar regions
of the spine. Can be a deformity if it is excessive.
These are bands of fibrous tissue that bind a joint and control
its range of movement.
The area of the spine between the thoracic vertebrae and the
An imprecise term for low back pain.
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
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!
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.
Pain in the distribution of a nerve or nerves
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.
A receptor preferentially sensitive to a noxious stimulus
or to stimuli that would become noxious if prolonged.
The core of the intervertebral disc. It has a high fluid content
in our early years and then dries out with age.
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.
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.
This is extra bone growth on the edges of the vertebrae which
can cause narrowing of the nerve canals.
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
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
An abnormal sensation (such as burning, prickling formication),
whether spontaneous or evoked.
Scar tissue formation around the dura.
This can be as a result of natural degenerative processes
or of invasive treatments, such as surgery.
The area of the spine between the lumbar vertebrae and the
coccyx, which consists of 5 fused vertebrae.
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 kvphotic (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
A sideways curvature of the spine, which can be caused by
a congenital deformity or a temporary reaction caused by muscle
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.
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.
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.
A prefix meaning the vertebrae or the spinal column.
Inflammation of any of the spinal vertebrae. This can be because
of injury, infection or rheumatoid disease (see Ankylosing
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 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
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
Term used to denote a collection of symptoms, e.g. chronic
The region of the spine between the neck and the lumbar vertebrae.
The ribs connect with the 12 thoracic vertebrae.
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
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,
Vertebrae (Plural) Vertebra (Single)
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.
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