Explaining commonly used terms and conditions

Explaining commonly used terms and conditions

Patients frequently tell us that medical terms and jargon can be confusing and often makes them worry more about what is going on with their body.  This section gives a brief outline about what many of these terms and conditions mean and how they are treated.

Common conditions

Ankylosing spondylitis (AS) – Ankylosing spondylitis is a rare condition where your body’s immune system becomes overactive and causes inflammation within the joints.  It can affect any part of your body but most commonly affects the spine and hips.  It is treated with a combination of medication and regular exercise.

Arthritis – Arthritis means inflammation of the joint.  When most people talk about arthritis they are referring to osteoarthritis (see below).  However, there are other, less common types of arthritis such as rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis (see below).  These conditions are much rarer and are caused by the body’s immune system becoming overactive and causing inflammation within the joints.

Chronic Fatigue Syndrome (CFS) – Chronic fatigue syndrome (also known as myalgic encephalomyelitis or ME) is a long term illness which can cause excessive tiredness, widespread pain, problems with memory and concentration and stomach problems.  Fatigue is not usually relieved by sleep or rest, even with larger than usual amounts of sleep.  The causes of chronic fatigue syndrome are not fully understood, but several factors are likely to contribute to the development of the condition.  Sometimes symptoms start after a viral illness, whilst in others, stress, sleep disturbance, an accident or other illness can be the trigger.  In many people there is no definite cause for the onset of symptoms.  Chronic Fatigue Syndrome does not benefit from excessive rest and you should aim to remain as active as possible.  Gradually building up your exercise tolerance, changing your sleep habits and slowly returning to your normal activities can help to improve the condition.  Cognitive Behavioural Therapy (a talking therapy) can also be helpful in managing your symptoms. 

Degenerative changes – Degenerative changes refer to the normal age-related changes that affect all of our spines and joints as we get older.  In the same way that we change on the outside (for example getting grey hair or wrinkly skin) our joints change on the inside.  These changes happen in almost everyone and are not related to whether you get pain or not.  A recent study looked at how common degenerative changes were in the back in people without any back pain.  It found that half of thirty year olds had “degenerative changes” on MRI scan.  This figure rose to 80% of 50 year olds and 90% of 70 year olds!  Remember, none of these people had any pain.  The key message is that degenerative changes are normal and not something to worry about.  

Degenerative disc disease – Degenerative disc disease refers to the normal changes to the discs in our spine that occur once we stop growing at around 20.  See above in the degenerative changes section for more details.

Fibromyalgia – Fibromyalgia is a condition that causes pain in lots of different parts of the body.  It can also cause tiredness, concentration and memory problems (often referred to as “fibro fog”) as well as an array of other unusual symptoms.  There is not one single cause for fibromyalgia and many different factors are thought to contribute.  It is thought that when people develop fibromyalgia their nervous systems become too sensitive, causing pain nerves to send messages to the brain when they shouldn’t.  There can be many different causes of this and most commonly it is a combination of a number of factors that leads to a person developing fibromyalgia.  Pain in other body parts, poor sleep, lack of exercise, traumatic events, anxiety, depression and low mood are all thought to contribute.  There is no cure for fibromyalgia but a combination of exercise, psychological support and occasionally certain medications can help to control symptoms and improve quality of life.

Mechanical lower back pain – Most episodes of lower back pain are not caused by an injury and do not have a serious underlying cause.  This referred to as mechanical back pain, or sometimes simple back pain or non-specific back pain.  This does not mean that the condition is not extremely painful, just that there is no problem that requires surgery or other invasive treatments.  There are no medications or surgical procedures that will cure back pain, but the symptoms can be relieved by taking regular exercise, gradually building up your activity and getting appropriate psychological support. 

Osteoarthritis – Osteoarthritis refers to the thinning of the smooth cartilage that lines all of our joints.  This process happens to everyone to some extent as they get older, but can occur at different rates.  Using the joint or exercising will not “wear the joint out” more – on the contrary.  Regularly exercising and strengthening muscles around joints has been shown to reduce pain and stiffness associated with osteoarthritis, although this may be a little painful to begin with.  Any exercise which improves your fitness will be helpful for osteoarthritis.  Sometimes you may be referred to a physiotherapist to teach you some specific exercises to help to strengthen certain muscles.

Psoriatic arthritis – Psoriatic arthritis is a condition similar to ankylosing spondylitis (see above) where the body’s immune system becomes overactive.  It is thought to affect 1 in 10 people with the skin condition psoriasis.  It is treated with a combination of medication and regular exercise.

Radiculopathy – This is the medical name for sciatica (see below).

Rheumatoid arthritis – Rheumatoid arthritis is a condition where the body’s immune system becomes overactive and causes inflammation in the joints.  It usually affects the joints on both sides of the body equally and is more common in the arms and legs than in the spine.  It is treated with a combination of medication and regular exercise.

Sciatica – Sciatica occurs when one of the nerves in your back becomes irritated.  This causes pain in the leg, which is sometimes accompanied by pins and needles, numbness and muscle weakness.  Nine out of ten times sciatica gets better by itself, but this can take as long as a year to fully resolve.  Sometimes injections known as epidurals are used to reduce sciatic pain.  Very occasionally surgery is required.

Spondylolisthesis – The bones of the spine usually sit directly on top of each other, with a disc in between.  As we get older, our spines change and the discs change shape slightly (see degenerative changes for more details).  Because of this one of the bones will sometimes sit slightly further forwards than the other, although it is still just as securely fastened to the bone above and below.  This is known as a spondylolisthesis and it is graded from 1-4, depending on how much further forward the bone is.  The vast majority of spondylolistheses involve the bone sitting only very slightly forward and do not cause any pain or require any treatment.  Very occasionally a spondylolisthesis can cause some nerve irritation and give you some symptoms into the leg.  In these cases other treatments may be required, but this is very rare.  Less commonly a spondylolisthesis can affect younger people due to an injury or due to the bones in their back forming slightly differently.  In most cases this does not require any different treatment.

Spondylosis – Spondylosis means osteoarthritis of the spine and is a normal part of the aging process.   Spondylosis is often used interchangeably with degenerative changes (see above), which often leads to people worrying that they have two separate problems, when they actually refer to the same condition.  As with arthritis of any joint, the best way to treat spondylosis is to keep moving, exercise regularly and keep the muscles around the joint strong.  Remember, you can’t make anything worse or wear things out” more through being active.

Commonly used terms

Cervical – The bones of the spine are divided into five different areas.  Cervical refers to the seven bones which make up the neck.

Coccyx – The bones of the spine are divided into five different areas.  The coccyx are the bones at the very tail end of our spine in the area which we sit on.  The coccyx have lots of ligaments attaching to them to keep our spines and pelvis strong.

Cognitive behavioural therapy (CBT) – Cognitive behavioural therapy is a talking therapy that aims to help you understand the links between your thoughts, behaviours and pain and disability.  It will help you develop useful and practical plans and strategies to manage your pain and improve how much activity you can do.

Discs – Discs are the tough, fibrous tissues that sit between the bones in our spine.  They allow the spine to be very flexible whilst remaining very strong.  Discs change in everyone as we get older, but they remain just as strong, if not quite as flexible, as when we were younger.

Epidural – An epidural injection is a procedure sometimes used to help people who have severe leg pain because of nerve irritation in the back.  It involves an injection of some steroid around the nerve in the back to help to reduce inflammation.  It is not usually necessary to have more than one injection.

Facet joint injections – Facet joint injections involve steroid being injected around the small joints at the back of the spine.  These used to be done regularly for back pain.  However, research has shown that they are not the most effective way to manage back pain.  In addition, the effects are usually temporary and tend to be less effective the more they are repeated.  For these reasons facet joint injections are no longer recommended for the treatment of back pain.

Lumbar – The bones of the spine are divided into five different areas.  Lumbar refers to the five bones in the lower back.

Pain Management Programme (PMP) – Pain management programmes are delivered in small groups, usually of 8-10 people.  In the Bury Integrated Pain Service groups are delivered by physiotherapists and psychological wellbeing practitioners who specialise in persistent pain.  Pain management programmes can not cure pain, but most people find that their pain is better controlled after taking part.  The PMP will also help you to understand more about the causes of your pain and what you can do to control it.  It will help you develop practical strategies to increase how much activity you can do, get back to doing the things that you enjoy doing and help improve your mood.

Physiotherapy – Exercise is known to be helpful in managing persistent pain.  However, many people struggle to get into exercising as it can initially make your pain worse.  If this is the case physiotherapy can be extremely helpful in helping you find the exercises that are right for you.  Your physiotherapist will fully assess you and show you how to get parts of your body that are stiff or weak moving more freely.  They will also help you start and do some regular fitness exercises, which is important in the keeping your pain under control in the long term.  Most importantly, they will help you find exercises that you can do whilst still continuing with all of your other activities.

Nurse led rehabilitation – Pain can affect many different parts of the body and not all pain is to do with muscles and joints.  Some patients experience pain in other parts of the body, such as the abdomen or face.  If this pain has been fully investigated and no cause for it found then it is important to manage this pain as well as possible.  Your specialist pain nurse will help you understand the reasons why people get persistent pain and what you can do to help improve it. 

Radiofrequency denervation – Radiofrequency denervation is a procedure where a needle is inserted into your back under x-ray guidance.  Electrical current is then passed through the needle, causing it to heat up.  The heat alters the function of the nerves which are thought to be contributing to your pain and can help to ease symptoms for some people.  As radiofrequency denervation is a painful procedure, it is important to make sure that it will be helpful for you before it is carried out.  To do this a different procedure is carried out first, which is known as a diagnostic nerve block.  This involves local anaesthetic being injected around the nerve to see if this improves pain.  If this gives several months of pain relief on two separate occasions you may be suitable for radiofrequency denervation.  Radiofrequency denervation does not completely cure pain and does not work for everybody.  It is best used in conjunction with other treatments, such as physiotherapy or cognitive behavioural therapy.

Sacrum – The bones of the spine are divided into five different areas.  The sacrum is the large bone which forms a joint with the pelvis to securely attach the spine to our lower body.

Sacro-illiac joint – This is the large joint at the bottom of the spine where the spine fastens to the pelvis.  It is held together by extremely strong ligaments and only moves a tiny amount.

Talking therapies – Talking therapies (or psychological therapies) can take different forms and can be helpful ways to improve pain.  They are also very helpful in managing problems with sleep, anxiety and depression.  Different therapies work in different ways.  They can help you to understand how stress and low mood impacts on your pain, and how to find ways of breaking this vicious cycle. Some aim to help you develop practical strategies to improve your symptoms and quality of life.  Others may involve looking into other factors that might be related to pain or your mental health, for example trauma or loss.

Thoracic – The bones of the spine are divided into five different areas.  Thoracic refers to the twelve bones in the middle of the back.  The thoracic spine is where our rib cage attaches.