Pain is a subjective uncomfortable sensation that results from damage to nerves. Pain can either be acute or chronic. Pain has two aspects – the physiological and psychological aspects. Therefore, there has to be a well-rounded treatment involved commonly termed “pain management.” There are different types of pain – nociceptive pain results from injury which communicates with pain receptors in the body; neuropathic pain involves pain that occurs even after healing due to changes in the nervous system; psychogenic pain occurs in patients who are anxious or depressed usually due to chronic pain.
Pain Management/Pain Medicine
Pain management is comprised of the overall pain treatment options for patients with pain. It utilizes scientific pain treatments as well as alternative methods of healing such as massage therapy. Pain management can also be a program that serves as a follow-up for surgery. There are currently several practices called “pain clinics” that offer the services of an interdisciplinary team for a single patient’s pain treatments. Every member of the team works to achieve the same goal. An interdisciplinary team may be made up of physicians, nurses, physical therapists, recreational therapists, pharmacists, and support staff.
Pain medication consists of all prescription and non-prescription (over-the-counter, OTC) drugs used to alleviate the symptoms of pain. For low back pain, two types of OTC pain medications are common – acetaminophen and NSAIDs. Stronger medications are often prescribed for a shorter duration, such as narcotics and muscle relaxants.
Pars interarticularis is the small segment of bone that connects the facet joints on the back side of the spine. During the process of back extension, the pars interarticularis is the segment that is stressed. During rapid growth of bones, there may be pain or weakness in the pars interarticularis. A defect in the pars interarticularis leads to a condition called spondylolysis.
Pathology is the study of disease. Pathologists can understand the nature and causes of diseases by examining specimens of tissue or blood. After specimens are thoroughly examined, a “pathology report” is given to the patient documenting a given diagnosis. Pathology is also the term that describes a disease, its root cause, classification, progression, symptoms, and side-effects.
Patient Controlled Analgesia (PCA)
Patient controlled analgesia (PCA) is a system of taking medication by self using a pump that is pre-programmed. The pump is connected to the patient through an IV and the patient simply presses a button to dispense the medication. The medications are filled with limited doses. The common medication used in PCA pumps is morphine.
A pedicle is a paired bone structure that joins the vertebral body to the lamina thereby forming the vertebral arch. The pedicle is also found at the bottom of the articular processes. Pedicles function as the lateral (side) wall of the spinal canal and hence protect the internal structures, i.e. the spinal cord and nerve roots in the lumbar region.
Peridural fibrosis is an adhesion or scar made up of extradural fibrous tissue. It is a common complication of lumbar surgery. Peridural fibrosis causes the Dura matter and nerve roots to adhere to erector muscles of the spine behind and to the disc and vertebral body in front. Peridural fibrosis produces an inflammatory and fibroblastic response that can be prevented by NSAIDs which can serve as a chemical barrier when used before a lumbar surgery. Some surgeons may do a prior surgery to place physical barriers before the actual lumbar surgery.
The periosteum is a protective layer of dense connective tissue which surrounds a bone. It is the surface to which muscles, tendons, and ligaments attach. The periosteum captures the nerve endings of neurons so it can be controlled by the brain. It also encapsulates blood vessels for the nourishment of the bone.
A physiatrist is an osteopathic medical doctor whose specialty is physical medicine and rehabilitation. They are also known as PM&R physicians. Physiatrists apply a wide variety of non-surgical approaches to treatment of pain in the musculoskeletal system. They are also known to approach treatment with a “whole person” perspective and not just focus on the problem area.
A physical therapist is a professional licensed to administer therapy for building strength and improving movement after an illness, accident, or surgery such as back surgery. They are able to test and measure a patient’s strength, motion, balance and coordination, maintenance of body posture, performance of muscles, respiration, and function of motor skills. Over time, they help patients regain normal movement.
Physical therapy is the process by which a physical therapist helps a patient to obtain normal movement or flexibility after impairment. It involves the rehabilitation of a patient during which muscle strength is tested and measured, as well as motion, balance and coordination, maintenance of body posture, performance of muscles, respiration, and function of motor skills. It also involves using several methods to relieve pain, such as electrical stimulation, hot packs, cold compresses, deep-tissue massages, and ultrasound technology.
The piriformis muscle is the muscle that makes up the buttocks. It begins at the front of the sacrum and passes through the greater sciatic notch, and finally attaches on the top section of the femur (thigh bone). The sciatic nerve can be found right behind the piriformis muscle, so there is a potential for the muscle to push on the sciatic nerve causing compression and irritation of the nerve. This can ultimately lead to piriformis syndrome.
Piriformis syndrome is a rare muscular disorder in which the piriformis muscle pushes on the sciatic nerve causing compression or irritation of the nerve. This leads to pain in the patient as well as tingling sensations and numbness in the buttocks. Treatment for piriformis syndrome starts with exercises and massages, and in some cases anti-inflammatory prescription drugs may be given. A corticosteroid injection near the site of compression may provide temporary relief.
Posterior Lumbar Interbody Fusion (PLIF)
Posterior lumbar interbody fusion (PLIF) is a spinal fusion technique that involves removal of the disc through the back of the body and insertion of a bone graft into the intervertebral space. An incision is first made on the back and the left and right erector spinae muscles are opened up. The disc is then removed and a bone graft inserted to fill the space. The bone graft stimulates bone growth between the two vertebral bodies on either side of the bone graft.
Posterolateral Gutter Fusion Surgery
Posterolateral gutter fusion surgery is a technique that places a bone graft in the posterolateral region of the spine right under the back muscles attached to the transverse processes of the impaired vertebrae. This surgery is considered to be the gold standard out of all other spinal fusion surgeries. The bone graft is either obtained from the pelvis of the patient or sometimes an alternative bone graft substitute is used. The risk of this surgery is a failed spinal fusion and a subsequent surgery may be required.
Powered Surgical Instruments
Powered surgical instruments are instruments with a motorized source of power. Such instruments are increasingly used in orthopedic and neurological surgeries. For decades powered surgical instruments were not used much due to the close proximity of bones to spinal nerves. However, there is an ongoing development of “intelligent” powered surgical instruments which have sensors to detect danger spots. Categories of powered surgical equipment include pneumatic large bone, battery or electric large bone, pneumatic small bone, electric small bone, and high speed equipment.
Preclinical studies are drug experiments performed on animals which need to be approved by the FDA before they can be moved to clinical trials on human beings. Preclinical studies involve testing the drug for toxic and pharmacological effects. Both in-vitro and in-vivo experiments are carried out during preclinical studies.
Primary Care Physician
A primary care physician is a medical practitioner whose job is to be the first point of contact for initial medical care. A primary care physician is usually a general practitioner, family medicine doctor, internal medicine doctor, or pediatrician. The primary care physician usually makes referrals to a specialist for back pain treatment.
Prolotherapy is the process of injecting injured joints, ligaments and tendons with an irritant solution to stimulate the healing process. After back surgery, it may take longer for some injured ligaments and tendons to heal, so prolotherapy speeds up the healing process as well as decreases the associated pain. The injected solution is usually a sugar solution. Studies show that prolotherapy may be more effective when mixed with spinal manipulation or back exercises.
Prosthesis is an artificial structure designed to replace a body part. It is scientifically built both to look and function like the given body part. One recent FDA-approved (2014) prosthetic for the spine is the PRESTIGE® LP cervical disc which is used to replace impaired discs in the cervical region of the spine from C3-C7. It is made up of a titanium-ceramic alloy. Other approved cervical discs include the Mobi-C®, the PRESTIGE®, the ProDisc™-C, the BRYAN®, the SECURE®-C, and the PCM®. For the lumbar region of the spine, the PRODISC®-L is approved.
A psychiatrist is a physician who diagnoses and treats psychological disorders or illnesses, counsels patients, and provides on-going psychotherapy for some conditions. Psychiatrists can accurately distinguish between physical and psychological causes of distress. It is very common for a psychiatrist to see patients with chronic back pain as some of these patients may become depressed. Psychiatrists can prescribe medications such as antidepressants for psychological disorders.
A psychologist is a professional who holds a doctoral degree and is licensed to provide health interventions to patients suffering from psychological disorders. Some services of psychologists include psychological assessments, counseling, psychotherapy, and research. However, unlike psychiatrists, psychologists do not prescribe medications.
- Pain Management/Pain Medicine
- Pain Medication
- Pars Interarticularis
- Patient Controlled Analgesia (PCA)
- Peridural Fibrosis
- Physical Therapist
- Physical Therapy
- Piriformis Muscle
- Piriformis Syndrome
- Posterior Lumbar Interbody Fusion (PLIF)
- Posterolateral Gutter Fusion Surgery
- Powered Surgical Instruments
- Preclinical Studies
- Primary Care Physician
- Prolapsed Disk