Chronic Pain Management

Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months.

A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."''

Ankylosing spondylitis (AS, from Greek ankylos, bent; spondylos, vertebrae), previously known as 'Bechterews disease, Bechterew syndrome, and Marie Strümpell disease, a form of Spondyloarthritis''', is a chronic, inflammatory arthritis and autoimmune disease. It mainly affects joints in the spine and the sacroilium in the pelvis, causing eventual fusion of the spine.

It is a member of the group of the spondyloarthropathies with a strong genetic predisposition. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine.

Arthralgia (from Greek arthro-, joint + -algos, pain) literally means joint pain; it is a symptom of injury, infection, illnesses

(in particular arthritis) or an allergic reaction to medication.

According to MeSH, the term "arthralgia" should only be used when the condition is non-inflammatory, and the term "arthritis" should be used when the condition is inflammatory.

Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a group of diseases and mechanical abnormalities involving degradation of joints, including articular cartilage and the subchondral bone next to it. Clinical manifestations of OA may include joint pain, tenderness, stiffness, creaking, locking of joints, and sometimes local inflammation. In OA, a variety of potential forces?hereditary, developmental, metabolic, and mechanical?may initiate processes leading to loss of cartilage -- a strong protein matrix that lubricates and cushions the joints. As the body struggles to contain ongoing damage, immune and regrowth processes can accelerate damage. When bone surfaces become less well protected by cartilage, subchondral bone may be exposed and damaged, with regrowth leading to a proliferation of ivory-like, dense, reactive bone in central areas of cartilage loss, a process called eburnation. The patient increasingly experiences pain upon weight bearing, including walking and standing. As a result of decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis, and the leading cause of chronic disability in the United States.

"Osteoarthritis" is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although the "itis" of osteo arthritis is somewhat of a misnomer -- inflammation is not a conspicuous feature of the disease. Osteoarthritis is not to be confused with rheumatoid arthritis, an autoimmune disease with joint inflammation as a main feature. A common misconception is that OA is due solely to wear and tear, since OA typically is not present in younger people. However, while age is correlated with OA incidence, this correlation may illustrate that OA is a process that takes time to develop -- or that repair and regeneration that may keep pace with damage in the joints of younger people do slow with age. There is usually an underlying cause for OA, in which case it is described as secondary OA. If no underlying cause can be identified it is described as primary OA. "Degenerative arthritis" is often used as a synonym for OA, but the latter involves both degenerative and regenerative changes.

OA affects about 8 million people in the United Kingdom and nearly 27 million people in the United States, where it accounts for 25% of visits to primary care physicians and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the US population will have radiographic evidence of OA by age 65, although only 60% of those will show symptoms. In the United States, hospitalizations for osteoarthritis soared from about 322,000 in 1993 to 735,000 in 2006.Hospitalizations for Osteoarthritis Rising Sharply Newswise, Retrieved on September 4, 2008.

Avascular necrosis (also osteonecrosis, aseptic (bone) necrosis, ischemic bone necrosis, and AVN) is a disease resulting from the temporary or permanent loss of the blood supply to an area of bone. Without blood, the bone tissue dies and the bone collapses. If avascular necrosis involves the bones of a joint, it often leads to destruction of the joint articular surfaces (see Osteochondritis dissecans).

Osteophytes, also known as bone spurs, are bony projections that usually form along joints.

A bursa (plural bursae or bursas; ) is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of slimy fluid (similar in consistency to that of a raw egg white). It provides a cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement. Bursae are filled with synovial fluid and are found around most major joints of the body.

Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying upon the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem.

Carpal tunnel syndrome (CTS), or median neuropathy at the wrist, is a medical condition in which the median nerve is compressed at the wrist, leading to paresthesias, numbness and muscle weakness in the hand. Night symptoms and waking up at night is a characteristic of established carpal tunnel syndrome. They can be managed effectively with night-time wrist splinting in most patients.

The definitive treatment for carpal tunnel syndrome is carpal tunnel release surgery. This is effective at relieving symptoms and preventing further nerve damage, but established nerve dysfunction in the form of static (constant) numbness, atrophy, or weakness are usually permanent.

Most cases of CTS are idiopathic (without a specific cause). Some patients are genetically predisposed to develop the condition.

The diagnosis of CTS is often misapplied to patients who have activity-related arm pain, such as RSI.

Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives.

Neck pain, although felt in the neck, can be caused by numerous other spinal issues. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of your neck and head. The lower joints in the neck and those of the upper back create a supportive structure for your head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Neck pain may also arise from many other physical and emotional health issues.

Complex regional pain syndrome (CRPS) is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. The International Association for the Study of Pain has divided CRPS into two types based on the presence of nerve lesion following the injury.

* Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy, does not have demonstrable nerve lesions.

* Type II, formerly known as causalgia, has evidence of obvious nerve damage.

The cause of this syndrome is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site.

Degeneration of the intervertebral disc, often called "degenerative disc disease" (DDD) of the spine, is a condition that can be painful and can greatly affect the quality of one's life. While disc degeneration is a normal part of aging and for most people is not a problem, for certain individuals a degenerated disc can cause severe constant chronic pain.

A spinal disc herniation (prolapsus disci intervertebralis), informally and misleadingly called a "slipped disc", is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) allows the soft, central portion (nucleus pulposus) to bulge out. Tears are almost always posterior-ipsilateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of nerve root compression (see "chemical radiculitis" below). This is the rationale for the use of anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

Intervertebral discs (or intervertebral fibrocartilage) lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.

Spondylosis is a term referring to degenerative arthrosis of the joints between the centra of the spinal vertebrae and/or neural foraminae. In this condition the interfacetal joints are not involved. If severe, it may cause pressure on nerve roots with subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.

When the space between two adjacent vertebrae narrows, compression of a nerve root emerging from the spinal cord may result in radiculopathy (sensory and motor disturbances, such as severe pain in the neck, shoulder, arm, back, and/or leg, accompanied by muscle weakness). Less commonly, direct pressure on the spinal cord (typically in the cervical spine) may result in myelopathy, characterized by global weakness, gait dysfunction, loss of balance, and loss of bowel and/or bladder control. The patient may experience a phenomenon of shocks (paresthesia) in hands and legs because of nerve compression and lack of blood flow. If vertebrae of the neck are involved it is labelled cervical spondylosis. Lower back spondylosis is labeled lumbar spondylosis.

Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. It was first described in 1782 by Belgian obstetrician, Dr. Herbinaux. He reported a bony prominence anterior to the sacrum that obstructed the vagina of a small number of patients.Spondylolisthesis of the fifth lumbar vertebra causes pelvic abnormalities that affect the birth canal, usually requiring a Caesarean section in the case of pregnant women with the condition. This phenomenon has long been recognized by medical practitioners; see The term ?spondylolisthesis? was coined in 1854, from the Greek ?spondyl? for vertebrae and ?olisthesis? for slip. The variant "listhesis" is sometimes applied in conjunction with scoliosis. These "slips" occur most commonly in the lumbar spine.

A hangmans fracture is a specific type of spondylolisthesis where the C1 vertebra is displaced anteriorly relative to the C2 vertebra due to fractures of the C2 vertebras pedicles.

A vertebra (plural: vertebrae) is an individual bone in the flexible column that defines vertebrate animals, e.g. humans. The vertebral column encases and protects the spinal cord, which runs from the base of the cranium down the dorsal side of the animal until reaching the pelvis. From there, vertebra continue into the tail.

Vertebrae are defined by the regions of the vertebral column they occur in. Cervical vertebrae are those in the neck area. With exception of two sloth species (Choleopus and Bradypus) and the manatee (Trichechus) all mammals have seven cervical vertebraeFrietson Galis. 1999. 'Why do almost all mammals have seven cervical vertebrae? Developmental constraints, Hox genes and Cancer'.Journal of experimental zoology 285:19-26.. In other vertebrates it can range from a single vertebra in amphibians, to as many as 25 in swans or 76 in the extinct plesiosaur Elasmosaurus. The dorsal vertebrae range from the bottom of the neck to the top of the pelvis. Dorsal vertebrae attached to ribs are called thoracic vertebrae, while those without ribs are called lumbar vertebrae. The sacral vertebrae are those in the pelvic region, and range from one in amphibians, to two in most birds and modern reptiles, or up to 3 to 5 in mammals. When more than one sacral vertebrae are fused into a single structure, it is called the sacrum. The synsacrum is a similar fused structure found in birds that is composed of the sacral, lumbar, and some of the thoracic and caudal vertebra, as well as the pelvic girdle. Caudal vertebra compose the tail, and the final few can be fused into the pygostyle in birds, or into the coccygeal or tail bone in chimpanzees or humans.

Computed tomography (CT) is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.

CT produces a volume of data which can be manipulated, through a process known as "windowing", in order to demonstrate various bodily structures based on their ability to block the X-ray/Röntgen beam. Although historically the images generated were in the axial or transverse plane, Category: Wiktionary - :orthogonal|orthogonal to the long axis of the body, modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. Although most common in medicine, CT is also used in other fields, such as nondestructive materials testing. Another example is the DigiMorph project at the University of Texas at Austin which uses a CT scanner to study biological and paleontological specimens.

Endometriosis (from endo, "inside", and metra, "womb") is a medical condition in women in which endometrial like cells appear and flourish in areas outside the uterine cavity. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones. These endometrial-like cells in areas outside the uterus (endometriosis) are influenced by hormonal changes and respond similarly as do those cells found inside the uterus. Symptoms often worsen in time with the menstrual cycle.

Endometriosis is typically seen during the reproductive years; it has been estimated that it occurs in roughly 5% to 10% of women.Diagnosis and Treatment of Endometriosis - October 15, 1999 - American Academy of Family Physicians Symptoms may depend on the site of active endometriosis. Its main but not universal symptom is pelvic pain in various manifestations. Endometriosis is a common finding in women with infertility.

Tennis elbow, also known as "shooter's elbow" and "archer's elbow", is a condition where the outer part of the elbow becomes sore and tender. The accurate medical term is lateral epicondylalgia. It is a condition that is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody.Tennis elbow: even cricketers and housewives can get it, a Times of India article dated September 4, 2004

The condition is also known as lateral epicondylitis ("inflammation to the outside elbow bone"),What is tennis elbow? from the BBC Sport Academy website a misnomer as histologic studies have shown no inflammatory process. Other descriptions for lateral epicondylalgia are lateral epicondylosis, or simply lateral elbow pain.

Runge is usually credited for the first description in 1873 of the condition.Runge F. Zur Genese und Behandlung des Schreibekrampfes. Berliner Klin Wochenschr. 1873;10:245?248. The term tennis elbow was first used in 1883 by Major in his paper "Lawn-tennis elbow".Major HP. "Lawn-tennis elbow". BMJ. 1883;2:557.

Plantar fasciitis is a painful inflammatory process of the plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis.Plantar Fasciitis A Degenerative Process (Fasciosis) Without Inflammation http://www.japmaonline.org/cgi/content/abstract/93/3/234 The plantar fascia is a thick fibrous band of tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the five toes. The term fasciitis is a misnomer as studies of the tissue do not demonstrate inflammation. Plantar fasciosis is a more accurate diagnosis. It has been reported that plantar fasciitis occurs in two million Americans a year and 10% of the population over a lifetime.Risk factors for Plantar fasciitis: a matched case-control study. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. J Bone Joint Surg Am. 2003;85-A:872-877. It is commonly associated with long periods of work-related weight bearing. Among non-athletic populations, it is associated with a high body mass index.Heel Pain - Plantar Fasciitis. J Orthop Sports Phys Ther. 2008:38(4)http://www.orthopt.org/ICF/Heel%20Pain-Plantar%20Fasciitis%20-%20JOSPT%20-%20%20April%202008.pdf The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is increased probability of knee pains, especially among runners.

Chronic fatigue syndrome (CFS) is the most common name given to a variably debilitating disorder or disorders generally defined by persistent fatigue unrelated to exertion and not substantially relieved by rest, and accompanied by the presence of other specific symptoms for a minimum of six months. The disorder may also be referred to as post-viral fatigue syndrome (PVFS, when the condition arises following a flu-like illness), myalgic encephalomyelitis (ME), or several other terms. The etiology (cause or origin) of CFS is currently unknown and there is no diagnostic laboratory test or biomarker.

Fatigue is a common symptom in many illnesses, but CFS is a multi-systemic disease and is relatively rare by comparison. Symptoms of CFS include widespread muscle and joint pain; cognitive difficulties; chronic, often severe, mental and physical exhaustion; and other characteristic symptoms in a previously healthy and active person. CFS patients may report additional symptoms including muscle weakness, hypersensitivity, orthostatic intolerance, digestive disturbances, depression, poor immune response, and cardiac and respiratory problems. It is unclear if these symptoms represent co-morbid conditions or are produced by an underlying etiology of CFS. All diagnostic criteria require that the symptoms must not be caused by other medical conditions.

CFS is thought to have an incidence of 4 adults per 1,000 in the United States. For unknown reasons CFS occurs most often in people in their 40s and 50s, more often in women than men, and is less prevalent among children and adolescents. Full recovery from the condition occurs in only 5-10% of cases.

Whereas there is agreement on the genuine threat to health, happiness and productivity posed by CFS, various physicians' groups, researchers and patient advocates promote different nomenclature, diagnostic criteria, etiologic hypotheses and treatments, resulting in controversy about many aspects of the disorder. The name CFS itself is controversial as many patients and advocacy groups, as well as some experts, believe the name chronic fatigue syndrome stigmatizes, by not conveying the seriousness of the illness, and want the name changed.

Fibromyalgia (new lat., fibro-, fibrous tissue, Gk. myo-, muscle, Gk. algos-, pain, meaning muscle and connective tissue pain) is also referred to as FM or FMS. Fibromyalgia is characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term fibromyalgia syndrome for the condition. Other core symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia is frequently comorbid with psychiatric conditions such as depression and anxiety and stress-related disorders such as posttraumatic stress disorder. Not all people with fibromyalgia experience all associated symptoms. Fibromyalgia is estimated to affect 2-4% of the population.

Fibromyalgia is considered a controversial diagnosis, lacking scientific consensus as to its cause or causes. Many members of the medical community consider fibromyalgia a "non-disease" because of a lack of abnormalities on physical examination, the absence of objective diagnostic tests, and extensive overlap with other proposed conditions such as chronic fatigue syndrome and multiple chemical sensitivity. While historically considered either a musculoskeletal disease or neuropsychiatric condition, evidence from research conducted in the last three decades has revealed abnormalities within the central nervous system affecting brain regions that may be linked both to clinical symptoms and research phenomena. It should be noted, however, that these studies show only correlation, not causation, and some research suggests that fibromyalgia might be the result of childhood stress, or prolonged or severe stress. Although there is as yet no generally accepted cure for fibromyalgia, some treatments have been demonstrated by controlled clinical trials to be effective in reducing symptoms, including medications, behavioral interventions, patient education, and exercise.

Gout is caused by elevated levels of uric acid in the blood that crystallizes and deposits in joints, tendons, and surrounding tissues. It affects 1% of the Western populations at some point in their life. It is marked by recurrent attacks or acute inflammatory arthritis (red, tender, hot, swollen joint).

Treatment with NSAIDS, steroids, or colchicine improves symptoms. Once the acute attack has subsided levels of uric acid are usually lowered via lifestyle changes and long term prevention with allopurinal.

Historically, it was known as "the disease of kings" or "rich man's disease".

Cluster headache, nicknamed "suicide headache", is a neurological disease that involves, as its most prominent feature, an immense degree of pain. "Cluster" refers to the tendency of these headaches to occur periodically, with active periods interrupted by spontaneous remissions. The cause of the disease is currently unknown. It affects approximately 0.1% of the population, and men are more commonly affected than women.

Migraine is a neurological syndrome characterized by altered bodily perceptions, severe headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne (originally as "megrim", but respelled in 1777 on a contemporary French model). The French term derived from a vulgar pronunciation of the Late Latin word hemicrania, itself based on Greek hemikrania, from Greek roots for "half" and "skull".

The typical migraine headache is unilateral and pulsating, lasting from 4 to 72 hours;The International Classification of Headache Disorders, 2nd Edition symptoms include nausea, vomiting, photophobia (increased sensitivity to light), and phonophobia (increased sensitivity to sound). Approximately one-third of people who suffer migraine headache perceive an aura?unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur.

Initial treatment is with analgesics for the headache, an antiemetic for the nausea, and the avoidance of triggering conditions. The cause of migraine headache is unknown; the most common theory is a disorder of the serotonergic control system.

There are migraine headache variants, some originate in the brainstem (featuring intercellular transport dysfunction of calcium and potassium ions) and some are genetically disposed. Studies of twins indicate a 60 to 65 percent genetic influence upon their propensity to develop migraine headache. Moreover, fluctuating hormone levels indicate a migraine relation: 75 percent of adult patients are women, although migraine affects approximately equal numbers of prepubescent boys and girls; propensity to migraine headache is known to disappear during pregnancy, although in some women migraines may become more frequent during pregnancy.

Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988, are the most common type of primary headaches. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches.Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44(11):1147-57.

A calcaneal spur (or heel spur) is a radiological (X-ray) finding, and when it is located on the inferior aspect of the calcaneus, is often associated with plantar fasciitis and ankylosing spondylitis. A posterior calcaneal spur may also develop on the back of the heel at the insertion of the Achilles tendon.

An inferior calcaneal spur consists of a spike of calcification, which lies superior to the plantar fascia at the insertion of the intrinsic foot musculature onto the calcaneus. Until recently, an inferior calcaneal bone spur was erroneuously thought to develop at the insertion of the plantar fascia. While heel spurs are commonly associated with plantar fascitis, they are not caused by plantar fascitis and many people who suffer from plantar fascitis do not have heel spurs. Often times, inferior heels spurs do not have to be removed as part of the treatment for plantar fascitis. However, posterior heel spurs are often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis.

In anatomy, the term ligament is used to denote three different types of structures:

# Fibrous tissue that connects bones to other bones. They are sometimes called "articular ligaments", "fibrous ligaments", or "true ligaments".

# A fold of peritoneum or other membrane

# The remnants of a tubular structure from the fetal period of life

The first meaning is most commonly what is meant by the term "ligament". After briefly discussing the other two types of ligaments, the remainder of this article will focus upon the first type.

The study of ligaments is known as desmology (from Greek , desmos, "string";

and , -logia).

X-radiation (composed of X-rays) is a form of electromagnetic radiation. X-rays have a wavelength in the range of 10 to 0.01 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (3 × 1016 Hz to 3 × 1019 Hz) and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays. In many languages, X-radiation is called Röntgen radiation after Wilhelm Conrad Röntgen, who is generally credited as their discoverer, and who had called them X-rays to signify an unknown type of radiation.Novelline, Robert. Squires Fundamentals of Radiology. Harvard University Press. 5th edition. 1997. ISBN 0674833392.

X-rays from about 0.12 to 12 keV (10 to 0.10 nm wavelength), are classified as soft X-rays, and from about 12 to 120 keV (0.10 to 0.010 nm wavelength) as hard X-rays, due to their penetrating abilities.

Hard X-rays can penetrate solid objects, and their largest use is to take images of the inside of objects in diagnostic radiography and crystallography. As a result, the term X-ray'' is metonymically used to refer to a radiographic image produced using this method, in addition to the method itself. X-rays are a form of ionizing radiation, and exposure to them can be a health hazard. By contrast, soft X-rays can hardly be said to penetrate matter at all; for instance, the attenuation length of 600 eV (~ 2 nm) x-rays in water is less than 1 micrometer[http://physics.nist.gov/cgi-bin/ffast/ffast.pl?Formula=H2O&gtype=5&range=S&lower=0.300&upper=2.00&density=1.00]

The distinction between X-rays and gamma rays has changed in recent decades. Originally, the electromagnetic radiation emitted by X-ray tubes had a longer wavelength than the radiation emitted by radioactive nuclei (gamma rays). So older literature distinguished between X- and gamma radiation on the basis of wavelength, with radiation shorter than some arbitrary wavelength, such as 10?11 m, defined as gamma rays.

However, as shorter wavelength continuous spectrum "X-ray" sources such as linear accelerators and longer wavelength "gamma ray" emitters were discovered, the wavelength bands largely overlapped. The two types of radiation are now usually distinguished by their origin: X-rays are emitted by electrons outside the nucleus, while gamma rays are emitted by the nucleus.

Low back pain ( or lumbago) is a common musculoskeletal disorders affecting 80% of people at some point in their life. It accounts for more sick leave and disability than any other medical condition. It can be either acute, subacute or chronic in duration. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.

The causes of lower back pain are varied. A traumatic event may result in either muscular pain or a vertebral fractures. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, an infection or tumor.

Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) is a disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. Disease onset usually occurs in young adults, and it is more common in females. It has a prevalence that ranges between 2 and 150 per 100,000. MS was first described in 1868 by Jean-Martin Charcot.

MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other. Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are wrapped in an insulating substance called myelin. In MS, the body's own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer effectively conduct signals. The name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) in the white matter of the brain and spinal cord, which is mainly composed of myelin. Although much is known about the mechanisms involved in the disease process, the cause remains unknown. Theories include genetics or infections. Different environmental risk factors have also been found.

Almost any neurological symptom can appear with the disease, and often progresses to physical and cognitive disability and neuropsychiatric disorder.Berrios G E & Quemada J I (1990) Andre G. Ombredane and the psychopathology of multiple sclerosis: a conceptual and statistical history. Comprehensive Psychiatry 31: 438?446 MS takes several forms, with new symptoms occurring either in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms). Between attacks, symptoms may go away completely, but permanent neurological problems often occur, especially as the disease advances.

There is no known cure for MS. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability. MS medications can have adverse effects or be poorly tolerated, and many patients pursue alternative treatments, despite the lack of supporting scientific study. The prognosis is difficult to predict; it depends on the subtype of the disease, the individual patient's disease characteristics, the initial symptoms and the degree of disability the person experiences as time advances. Life expectancy of patients is nearly the same as that of the unaffected population.

A spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. It is sometimes accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes. Spasmodic muscle contraction may also be due to a large number of medical conditions, including the dystonias.

By extension, a spasm is a temporary burst of energy, activity, emotion, stress, or anxiety.

A subtype of spasms is colic, an episodic pain due to spasms of smooth muscle in a particular organ (e.g. the bile duct). A characteristic of colic is the sensation of having to move about, and the pain may induce nausea or vomiting if severe. Series of spasms or permanent spasms are called a spasmism.

In very severe cases, the spasm can induce muscular contractions that are more forceful than the sufferer could generate under normal circumstances. This can lead to torn tendons and ligaments.

Hysterical strength is argued to be a type of spasm induced by the brain under extreme circumstances.

Spasms can be caused by insufficient hydration, muscle overload or absence of some minerals (such as magnesium).

Osteoporosis is a disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture. Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP). Given its influence in the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.

Osteoporosis can be prevented with lifestyle changes and sometimes medication; in people with osteoporosis, treatment may involve both. Lifestyle change includes exercise and preventing falls; medication includes calcium, vitamin D, bisphosphonates and several others. Fall-prevention advice includes exercise to tone deambulatory muscles, proprioception-improvement exercises; equilibrium therapies may be included. Exercise with its anabolic effect, may at the same time stop or reverse osteoporosis. Osteoporosis is a component of the frailty syndrome.

A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakened vertebra in a patient with osteoporosis or osteogenesis imperfecta.

Bone density (or bone mineral density) is a medical term referring to the amount of matter per square centimeter of bones. Note that this is not a true "density", which would be measured in mass per cubic area. It is measured by a procedure called densitometry, often performed in the radiology or nuclear medicine departments of hospitals or clinics. The measurement is painless and non-invasive and involves minimal radiation exposure. Measurements are most commonly made over the lumbar spine and over the upper part of the hip. The forearm is scanned if either the hip or the lumbar spine can't be. Average density is around 1500 kg m-3

Kyphoplasty is a medical procedure developed by orthopedist Mark Reiley that attempts to stop the pain caused by the bone fracture and attempts to restore the height and angle of kyphosis of a fractured vertebra (of certain types), followed by its stabilization using injected bone filler material. Kyphoplasty and vertebroplasty represent the two procedures that percutaneously attempt to augment the strength of fracture or weakened spine bones (Vertebra).

The procedure can be performed under either local or general anesthesia, on multiple levels, out-patient or in-patient, and is viewed as minimally invasive. It was most commonly performed for spinal compression fractures caused by osteoporosis, a condition that weakens the bone, and is also sometimes performed for certain other conditions that may have led to a spinal fracture.

Two trials published in 2009 however have found that the procedure in not effective at relieving pain or deformity.

Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD) or peripheral artery occlusive disease (PAOD), includes all diseases caused by the obstruction of large arteries in the arms and legs. PVD can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. It causes either acute or chronic ischemia (lack of blood supply), typically of the legs.

Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg. Diagnosis is often difficult due to few validated and standardized diagnostic tests, but one of the most important criteria is to exclude sciatica resulting from compression/irriation of spinal nerve roots, as by a herniated disk.

Piriformis Syndrome: Treatment & Medication The syndrome may be due to anatomical variations in the muscle-nerve relationship, or from overuse or strain.

Uncontrolled studies have suggested theories about the disorder, however a large scale formal prospective outcome trial using Class A study, designed as outlined by the American College of Physicians, found that the weight of the evidence-based medicine is that piriformis syndrome should be considered as a possible diagnosis when sciatica occurs without a clear spinal cause. The need for controlled studies is supported by studies of spinal disk disease that show a high frequency of abnormal disks in asymptomatic patients.

'Raynauds disease''' () is a vascular disorder that affects blood flow to the extremities (the fingers, toes, nose and ears) when exposed to cold temperatures or in response to psychological stress. It is named for Maurice Raynaud (1834 - 1881), a French physician who first described it in 1862.

Restless legs syndrome (RLS), also known as 'Wittmaack-Ekboms syndrome, and colloquially as "the jimmylegs"' is a condition that is characterized by an irresistible urge to move ones body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can also affect the arms or torso and even phantom limbs.Skidmore FM, Drago V, Foster PS, Heilman KM. (2009). Bilateral restless legs affecting a phantom limb, treated with dopamine agonists. J Neurol Neurosurg Psychiatry. 80(5):569-70. PMID 19372293 Moving the affected body part modulates the sensations, providing temporary relief.

RLS causes a sensation in the legs or arms that can most closely be compared to a burning, itching, or tickling sensation in the muscles. Some controversy surrounds the marketing of drug treatments for RLS. It is a 'spectrum' disease with some people experiencing only a minor annoyance and others experiencing major issues.

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue under the skin. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in its chronicity and progression.

About 1% of the world's population is afflicted by rheumatoid arthritis, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but people of any age can be affected. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility. It is diagnosed chiefly on symptoms and signs, but also with blood tests (especially a test called rheumatoid factor) and X-rays. Diagnosis and long-term management are typically performed by a rheumatologist, an expert in the diseases of joints and connective tissues.

Various treatments are available. Non-pharmacological treatment includes physical therapy,orthoses and occupational therapy. Analgesia (painkillers) and anti-inflammatory drugs, including steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are often required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times, the newer group of biologics has increased treatment options.

The name is based on the term "rheumatic fever", an illness which includes joint pain and is derived from the Greek word rheumatos ("flowing"). The suffix -oid ("resembling") gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of rheumatoid arthritis was made in 1800 by Dr Augustin Jacob Landré-Beauvais (1772-1840) of Paris.

Category: File - :Structural MRI animation.ogv|thumb|Para-sagittal MRI of the head, with aliasing artifacts (nose and forehead appear at the back of the head)

Magnetic Resonance Imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize detailed internal structure and limited function of the body. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging. Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field to align the nuclear magnetization of (usually) hydrogen atoms in water in the body. Radio frequency (RF) fields are used to systematically alter the alignment of this magnetization, causing the hydrogen nuclei to produce a rotating magnetic field detectable by the scanner. This signal can be manipulated by additional magnetic fields to build up enough information to construct an image of the body.

Canada is the leading producer of MRI machines.

Magnetic Resonance Imaging is a relatively new technology. The first MR image was published in 1973

and the first cross-sectional image of a living mouse was published in January 1974.

The first studies performed on humans were published in 1977.

By comparison, the first human X-ray image was taken in 1895.

Magnetic Resonance Imaging was developed from knowledge gained in the study of nuclear magnetic resonance. In its early years the technique was referred to as nuclear magnetic resonance imaging (NMRI). However, as the word nuclear was associated in the public mind with ionizing radiation exposure it is generally now referred to simply as MRI. Scientists still use the term NMRI when discussing non-medical devices operating on the same principles. The term Magnetic Resonance Tomography (MRT) is also sometimes used.

In medicine, sacroiliitis is an inflammation of the sacroiliac joint. Sacroiliitis is a feature of spondylarthropathies (such as ankylosing spondylitis, psoriatic arthritis, reactive arthritis or arthritis related to inflammatory bowel diseases including ulcerative colitis or Crohn's disease).

Sciatica (or sciatic neuritis) is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

The first cited use of the word sciatica was registered in 1451.Oxford English Dictionary, 2nd Ed. "a1450a Mankind (Brandl)."

Scoliosis (from Greek: skoli?sis meaning "crooked condition," from skolios, "crooked")Online Etymology Dictionary. Douglas Harper, Historian. Accessed 27 December 2008. Dictionary.com http://dictionary.reference.com/browse/scoliosis is a medical condition in which a person's spine is curved from side to side and may also be rotated. On an x-ray, viewed from the rear, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line. It is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred) or neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy or physical trauma). This condition affects approximately 7 million people in the United States. Christopher Good, M.D 'The Genetic Basis of Adolescent Idiopathic Scoliosis' Journal of the Spinal Research Foundation, Spring 2009 Vol 4.1 http://www.spinemd.com/publications/articles/the-genetic-basis-of-adolescent-idiopathic-scoliosis

Myelography is a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. The procedure often involves injection of contrast medium into the cervical or lumbar spine, followed by several X-ray projections.

A myelogram may help to find the cause of pain not found by an MRI or CT.

Myelography has been largely replaced by the use of CT and MRI scans.

A CT is typically performed after myelographic material has been placed with fluoroscopic guidance. A CT myelogram is most useful for patients who cannot undergo MRI (eg those with pacemakers or cochlear implants) or for those in whom MRI provides limited information (eg those with extensive metal in the spine).

The process usually involves lying face down on a table, with the lower extremities secured tightly with straps to the table. The radiologist (or neurosurgeon) will perform the spinal tap, introducing the contrast medium. The table is then slowly rotated in a circular motion, first down at the head end for approximately 4-6 minutes, then rotated up at the head end for the same duration. Several more minutes lying flat and the process is complete. This movement insures the contrast has sufficiently worked its way through the spinal cord.

It is very important not to lift anything for at least 24 hours following this procedure and to lie flat for at least the same amount of time. There is a high chance that excessive movement or any lifting will release the 'plug' at the site of the spinal tap, and CSF will then drain from your brain and cause very severe headaches. This can be corrected by returning to the medical facility and having them perform a blood patch: a small amount of blood is taken from your arm and injected into the exact spinal tap location to stop the leaking of CSF.

Rotator cuff tears are tears of one, or more, of the four tendons of the rotator cuff muscles. A rotator cuff injury can include any type of irritation or damage to your rotator cuff muscles or tendons.http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192

Rotator cuff tears are among the most common conditions affecting the shoulder.

The tendons of the rotator cuff, not the muscles, are most commonly torn. Of the four tendons, the supraspinatus is most frequently torn; the tear usually occurs at its point of insertion onto the humeral head at the greater tuberosity.

Sickle-cell disease, or sickle-cell anaemia (or drepanocytosis), is a genetic life-long blood disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape. Sickling decreases the cells' flexibility and results in a risk of various complications. The sickling occurs because of a mutation in the hemoglobin gene. Life expectancy is shortened, with studies reporting an average life expectancy of 42 and 48 years for males and females, respectively.

Sickle-cell disease, usually presenting in childhood, occurs more commonly in people (or their descendants) from parts of tropical and sub-tropical regions where malaria is or was common. One-third of all indigenous inhabitants of Sub-Saharan Africa carry the geneSicklecell.md, because in areas where malaria is common, there is a survival value in carrying only a single sickle-cell gene (sickle cell trait).Sicklecell.md FAQ: "Why is Sickle Cell Anaemia only found in Black people? Those with only one of the two alleles of the sickle-cell disease are more resistant to malaria, since the infestation of the malaria plasmodium is halted by the sickling of the cells which it infests.

The prevalence of the disease in the United States is approximately 1 in 5,000, mostly affecting Americans of Sub-Saharan African descent, according to the National Institutes of Health.http://www.nhlbi.nih.gov/health/dci/Diseases/Sca/SCA_Summary.html In the United States, about 1 in 500 black births have sickle-cell anemia.

A tendon (or sinew) is a tough band of fibrous connective tissue that usually connects muscle to boneeMedicine/Stedman Medical Dictionary Lookup! and is capable of withstanding tension. Tendons are similar to ligaments and fascia as they are all made of collagen except that ligaments join one bone to another bone, and fascia connect muscles to other muscles. Tendons and muscles work together and can only exert a pulling force.

See also: Atypical trigeminal neuralgia

Trigeminal neuralgia (TN), tic douloureux (also known as prosopalgia) is a neuropathic disorder of one or both of the trigeminal nerves. Its nickname is "the suicide disease" because it causes one of the most severe pains that a human being can experience, and is not easily controlled or cured. It causes episodes of intense pain in any or all of the following: the ear, eye, lips, nose, scalp, forehead, teeth or jaw on one side of the face. It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although the actual figure may be significantly higher due to frequent misdiagnosis. TN usually develops after the age of 50, more commonly in females, although there have been cases with patients being as young as three years of age .

TN brings about stabbing, mind-numbing, electric shock-like pain from just a finger's glance of the cheek or spontaneously without any stimulation by the patient. Cold wind, high pitched sounds,loud noise such as concerts or crowds, chewing, talking, can aggravate the condition, and for the worst cases, even smiling or a scarf or the wind or hair on the side of the face is too much to bear.

Atypical Trigeminal Neuralgia (ATN), or Type 2 Trigeminal Neuralgia, is a rare form of Trigeminal neuralgia, a disorder of the fifth cranial nerve. This form of neuralgia is difficult to diagnose, as it is rare and the symptoms overlap with several other disorders. The symptoms can be mistaken for migraines, dental problems such as TMJ, musculoskeletal issues, and hypochondriasis. ATN can have a wide range of symptoms and the pain can fluctuate in intensity from mild aching to a crushing or burning sensation, and also to the extreme pain experienced with the more common trigeminal neuralgia.

Vulvodynia (also called "vestibulodynia") is a chronic pain syndrome categorized in the ICD-9 group 625?specifically ICD-9 625.7, which is for pain and other disorders of the female genital organs.http://www.icd9data.com/2009/Volume1/580-629/617-629/625/default.htm It refers to pain of the vulva unexplained by vulvar or vaginal infection or skin disease.http://medical-dictionary.thefreedictionary.com/vulvodynia

Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components.Seligman, M.E.P., Walker, E.F. & Rosenhan, D.L. (2001). Abnormal psychology, (4th ed.) New York: W.W. Norton & Company, Inc. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.

Anxiety is a generalized mood condition that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat. Additionally, fear is related to the specific behaviors of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable.Ohman, A. (2000). Fear and anxiety: Evolutionary, cognitive, and clinical perspectives. In M. Lewis & J. M. Haviland-Jones (Eds.). Handbook of emotions. (pp.573-593). New York: The Guilford Press.

Another view is that anxiety is "a future-oriented mood state in which one is ready or prepared to attempt to cope with upcoming negative events" suggesting that it is a distinction between future vs. present dangers that divides anxiety and fear.

Anxiety is considered to be a normal reaction to stress. It may help a person to deal with a difficult situation, for example at work or at school, by prompting one to cope with it. When anxiety becomes excessive, it may fall under the classification of an anxiety disorder.National Institute of Mental Health Retrieved September 3, 2008.

:For other depressive disorders, see Types of psychological depression.

Major depressive disorder (also known as clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) classification, and has become widely used since. The general term depression is often used to describe the disorder, but as it can also be used to describe other types of psychological depression, more precise terminology is preferred for the disorder in clinical and research use. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide have depression or another mood disorder.

The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status exam. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 30 and 40 years, with a later peak between 50 and 60 years. Major depression is reported about twice as frequently in women as in men, and women attempt suicide more often, although men are at higher risk for completing suicide.

Most patients are treated in the community with antidepressant medication and some with psychotherapy or counselling. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT), under a short-acting general anaesthetic. The course of the disorder varies widely, from one episode lasting months to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. Current and former patients may be stigmatized.

The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and many aspects of depression are still the subject of discussion and research. Psychological, psycho-social, hereditary, evolutionary and biological causes have been proposed. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine, and dopamine, which are naturally present in the brain and assist communication between nerve cells. Monoamines have been implicated in depression, and most antidepressants work to increase the active levels of at least one.

Insomnia is a symptom which can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep despite the opportunity. Insomnia is typically followed by functional impairment while awake. Both organic and non-organic insomnia without other cause constitute a sleep disorder, primary insomnia.

According to the United States Department of Health and Human Services in the year 2007, approximately 64 million Americans regularly suffer from insomnia each year. Insomnia is 1.4 times more common in women than in men.

Posttraumatic stress disorder; on-line (commonly referred to by its acronym, PTSD) is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's psychological defenses.

PTSD is a less frequent and more enduring consequence of psychological trauma than the more frequently seen acute stress response.

PTSD has also been recognized in the past as railway spine, stress syndrome, shell shock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome.

Diagnostic symptoms include re-experiencing original trauma(s), by means of flashbacks or nightmares; avoidance of stimuli associated with the trauma; and increased arousal, such as difficulty falling or staying asleep, anger, and hypervigilance. Formal diagnostic criteria (both DSM-IV and ICD-9) require that the symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and/or relationships).

Biofeedback is a non-medical process that involves measuring a subject's specific and quantifiable bodily functions such as the activity of brain waves, blood pressure, heart rate, skin temperature, sweat gland activity, and muscle tension, conveying the information to the patient in real-time. This raises the patient's awareness and therefore the possibility of conscious control of those functions.

By providing the user access to physiological information about which he or she may be unaware, biofeedback may allow users to gain control of physical processes previously considered an automatic response of the autonomous nervous system. Interest in biofeedback has waxed and waned since its inception in the 1960s; it is, however, undergoing something of a renaissance during the early 21st century, which some experts attribute to the general rise in interest about all alternative medicine modalities. Small biofeedback machines are becoming available for use in the home.

The "Association for Applied Psychophysiology and Biofeedback", or "AAPB" is a non-profit scientific and professional society for biofeedback practitioners. Originally called "The Biofeedback Research Society", its name was first changed to the "Biofeedback Society of America," and then it was once again changed to its latest name.

Music therapy is an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health. Music therapists primarily help clients improve their observable level of functioning and self-reported quality of life in various domains (e.g., cognitive functioning, motor skills, emotional and affective development, behavior and social skills) by using music experiences (e.g., singing, songwriting, listening to and discussing music, moving to music) to achieve measurable treatment goals and objectives. Referrals to music therapy services may be made by a treating physician or an interdisciplinary team consisting of clinicians such as physicians, psychologists, social workers, physical therapists, and occupational therapists.

In some instances, the client's needs are addressed directly through music; in others they are addressed through the relationships that develop between the client and therapist. Music therapy is used with individuals of all ages and with a variety of conditions, including: psychiatric disorders, medical problems, physical handicaps, sensory impairments,...