Sex and back pain. Is there a link?

It is not surprising that back pain has effects on people´s sex life, it may be that it affects either performance or definitely stops sex altogether if it is a serious injury.

There are no reliable statistics about the number of people who put aside sex for a sore back, mainly because most people do not like to talk about sex with their doctors. But it is logical to think that a back pain can make sex a nuisance as well.

Having pain can complicate provoking pleasurable sensations, which in turn make it difficult to get turned on and have an orgasm. Depending on the dose and the type of pain, the medicine can also interfere with arousal and orgasm in both men and women.

Fortunately, there is a guide to deal with the situation. Here are several ways to enjoy sex without back pain.

-Talk about it: Back pain can be deceptive because it does not show symptoms at a glance and makes people look good, even if they feel terrible. What greater reason to have your partner informed.

According to experts, this will help to not just abandon sex, but to team up and find ways to make sex more comfortable and enjoyable.

-Work on the solution. Specialists in orthopedic injuries and neuromusculoskeletal impairments can guide their clients through exercises designed to lengthen and strengthen muscles. Yoga and pilates can also help. An experienced instructor, personal trainer or physical therapist can apply specific exercises and stretches that directly affect the problem area on your back.

-Make adjustments: It makes sense that, according to the location of the pain, some sexual positions will be more or less comfortable than others. People with lower back problems like sciatica or a herniated disc feel more pain when they lean forward, while those with stenosis have more pain when bending backwards.

-Let your body guide you: If your back hurts when you are lying down, you should be up during sex, or vice versa. Side positions can take pressure off your back.

-Experiment using a pillow under your lower back, stomach, knees or neck to see if an extra support helps, or try to angle with a pillow to make certain positions more comfortable.

-Explore other options: Playing is important for you and your partner. A shower or massage can help relax the muscles before sex.

Most of the discomforts that cause back pain are resolved with time and care. So, choose to make some changes in the bedroom or decide that rest is your priority, there is no need to disappear all sexual activity. Take that annoyance as an opportunity to connect and communicate with your partner.

How to diagnose osteoporosis?

Osteoporosis is a progressive disease of the skeleton, characterized by a decrease in bone strength that facilitates the development of fractures. It is the second healthcare problem in the world after cardiovascular diseases, according to the World Health Organization (WHO). Its prevalence is increasing given the progressive aging of the population.

During aging the loss of bone mass continues, both at the level of the spine and the hip, which has begun in postmenopause in women, and around 60 years in men. In old age, it is also when the great majority of fractures due to bone fragility occur, whose incidence increases exponentially in those over 75 years of age.

Diagnosis

In all patients with clinical suspicion of osteoporosis should be made an interrogatory, physical examination and a series of complementary examinations, largely aimed at identifying possible underlying processes that determine secondary forms of the disease.

The diagnosis of osteoporosis can be made from the presence of a fragility fracture (low-intensity trauma), but it is very important to diagnose the disease before this complication appears. Therefore, at present the term osteoporosis is used more and more to describe cases of bone mineral density (BMD) decline before any fracture has occurred, calling severe or established osteoporosis to cases where fractures have happened. The asymptomatic condition of osteoporosis then makes the diagnosis depend on, on the one hand, the individual estimation of fracture risk and, on the other, much more objective, on methods that quantify bone mass and assess bone quality. The estimation of the risk of fracture is complicated by the number of involved factors in the etiopathogenesis of the disease, this together with the lack of techniques that measure the quality of bone, means that at present doctors base the diagnosis of osteoporosis mainly on the assessment of BMD.

The only bone measurement technique currently recognized and validated by WHO is double-beam densitometry. The densitometric criteria established by the WHO establish the diagnosis of osteoporosis according to the value of the T-score (taking as reference the peak of bone mass or maximum population value, which is the average of the young adult).

Why did I develop Osteoporosis?

Osteoporosis is a disease with a multifactorial origin, meaning that it is caused by several causes. Classically the causes of this disease can be classified into two distinct groups, which are:

Non-modifiable risk factors:

These are the risk factors on which we cannot act to reduce the risk of osteoporosis, and they are the following:

-The genetics of the person: Between 46% and 62% of bone mass is attributable to genetic factors, and predispose to low bone density; that means, if our parents and grandparents have suffered from osteoporosis, we are at great risk of suffering from it too.

-Sex: Women are much more at risk of osteoporosis than men.

-Age: The risk of suffering from this disease increases with age. In women, this risk significantly increases the risk of osteoporosis after menopause. From 70 to 75 years, this risk is much more important due to the consequences of a fracture.

-Menopause: From this stage and due to the lack of estrogen production, there is an accelerated loss of bone, which ends up triggering osteoporosis.

-Various diseases: There are several diseases that favor the loss of bone mass or osteoporosis, among them, we have: Rheumatoid arthritis, anorexia nervosa, celiac disease, liver diseases, hyperthyroidism, etc.

Modifiable risk factors:

Within this group, we have a number of factors that favor the development of osteoporosis, but they are factors on which we can perform an intervention so that we can reduce the risk of osteoporosis somewhat. They are the following:

-BMI <10: Those women or men who have a Body Mass Index below 10, have a higher risk of suffering from osteoporosis since it stimulates the destructive activity of the bone and does not favor the reconstruction.

-Low calcium intake: The low intake of this mineral so necessary for the formation of bone, favors the development of osteoporosis. It has a low level of absorption, around 30% of what is ingested and there are also substances in plants such as phytates and oxalates that further inhibit their absorption. Therefore, if we associate a low intake with the difficulty of absorbing this mineral, will favor low bone mineralization and consequent osteoporosis.

-Low levels of vitamin D: The absorption of calcium is not only linked to its deficit, but also to adequate levels of vitamin D.

-Hyperproteic diets: The consumption of diets with high levels of proteins favor the renal excretion of calcium.

-Smoking: The consumption of more than 20 cigarettes a day favors the loss of bone mass.

-Caffeine: Its high consumption also favors the elimination of calcium.

-Alcohol: A high consumption decreases the action of the osteoblasts that are the bone-forming cells.

-Sedentary habit: The lack of exercise favors the loss of bone mass since there are no stimuli on the bone that favor its formation.

-Drugs: The consumption of certain medications for long periods of time, favor the decrease in bone mineralization or osteoporosis, such as corticosteroids, immunosuppressants, anticoagulants, and heparin.

Treating cancer of the spine


The main objective of the treatment of a vertebral tumor is to eliminate the tumor completely. However, this can be complicated by the risk of permanent damage to the spinal cord or nearby nerves.
Approximately 90% of all spine tumors are metastatic as a result of the dissemination of cancer cells from the initial tumor to another part of the body.
Propagation mechanisms
The mechanism of metastatic dissemination of malignant tumors in the region may vary and includes:
– Hematogenous: through the blood stream, arterial or venous.
– Direct invasion: from a close tumor.
Breast cancer, lung cancer and melanoma are usual sources of spinal metastasis. Renal tumors, prostate cancer, multiple myeloma and lymphoma are other types of cancer that can spread to the spine.
This progression of cancer is regarded as an emergency and if not treated it can quickly progress to paralysis. Spinal cord compression often requires early multimodal management with medical, surgical and radiological interventions. For many years, conventional radiotherapy has been the most applied treatment for patients with metastatic spinal tumors.
Surgery
This is usually the treatment of choice for tumors that can be removed safely. The most modern techniques and instruments allow neurosurgeons to reach tumors in areas that were previously considered inaccessible. Occasionally, surgeons can use a high-powered microscope in microsurgery to facilitate the distinction between a tumor and healthy tissue.
Radiotherapy
This can be used after surgery to remove the remains of tumors that cannot be removed completely, treat inoperable tumors or treat those tumors where surgery is very risky. It is considered the first line therapy for some vertebral tumors.
Spinal radiosurgery
This offers a shorter duration of treatment; spinal radiosurgery provides a higher dose of radiation to a lesion compared to conventional radiation therapy. This results in a high-rate of tumor control and faster pain relief. The minimally invasive nature of this technique helps to keep or get better a patient’s quality of life. Spinal radiosurgery has broadened the neurosurgical treatment options for patients with spinal and paraspinal metastases, but also the primary tumors.
Spinal and paraspinal metastases are frequent complications of advanced cancer. The proportion of spinal metastasis is rising because patients are living longer due to recent advances in systemic therapy.
Chemotherapy
Chemotherapy is a conventional treatment for many types of cancer that involves using drugs to kill cancer cells or prevent their growth. The doctor can determine if chemotherapy could be beneficial for you, either alone or along with other therapies.
Other drugs
Since surgery and radiation therapy, but also tumors themselves, can cause inflammation within the spinal cord, doctors usually prescribe corticosteroids to reduce inflammation, either after surgery or during radiation treatments. When prescribed properly, pain medications (from over-the-counter medications such as ibuprofen or acetaminophen to more potent prescription medications such as morphine) are very effective.

5 major advances in spinal surgery


Spinal surgery supposes to operate a zone in contact with nervous tissue: nerves and/ or the spinal cord. Advances in spinal surgery enable better prevention of risks and complications during surgery, as well as get better the accuracy of surgery and minimize the time during and after the procedure. These are some of the most remarkable advances:
1- Balloon kyphoplasty is a minimally invasive treatment option for patients with vertebral compression fractures. In this procedure, orthopedic balloons are used to repair a vertebral fracture. Bone cement is then used to create an internal mold and stabilize the fracture. The problems that can be treated by balloon kyphoplasty are kyphosis, osteoporosis, and vertebral fractures.
2- The recent use of stem cells is like a medication, which should be used in the correct dose depending on the patient’s degenerative process.
3- Interspinous spacers: These are implanted between the bones of the back of the spine, known as the spinous process, at the level of the affected spine, which forces this level to flex forward. This movement relieves pressure on the nerves and consequently also relieves pain in the legs. A large number of patients have reported significant pain relief after the implantation of this device and current evidence shows that these procedures are effective in the short and medium term for carefully selected patients.
4- At present, the treatment of herniated discs has been resorted to using the Holmium-Yag Laser or “contact laser”, a technique that can be summarized as follows: A cannula is inserted percutaneously, of less thickness than a spare plastic ballpoint pen, which includes a laser fiber, a television micro-camera, irrigation and suction hoses, as well as having a mechanism that allows the tip of the laser fiber to be moved according to the requirements of the surgeon, allowing the doctor to have a very precise control over the instrument. Once inside, the surgeon goes exploring the affected disc by means of the video system, which gives a clear vision of exactly what the problem is. Applying the laser, the surgeon disintegrates the damaged parts of the affected intervertebral disc, thus reducing the disc pressure, providing immediate relief to the patient who is on the operating table.
5- Ozone therapy is especially effective in diseases of the vertebral area, especially in herniated discs.
The herniated disc takes place when the intervertebral disc moves to the nerve root and compresses or clamps the nerve. As a result, neurotoxic substances are secreted that irritate the nerve root and inflammatory and vascular phenomena that affect the surrounding tissues, which cause the pain associated with a hernia.
This is where ozone acts, improving the oxygen supply in the affected area and getting rid of pain and inflammation since it neutralizes and inhibits the production of neurotoxic substances and modulates the immune response. Ozone also dries the part of the disc that protrudes, which leads to its reduction or even disappearance.

Is laser disc surgery safe?

Disc pathology occurs mainly in adulthood and can generate several degrees of pain that in some cases becomes disabling, having an important impact on the quality of life, both at the family and work levels. Due to this, it carries an economic cost for companies and for the public health system. The most frequent and characteristic radicular pain is that produced by the herniated discs that appear with greater frequency in the lumbar region. The treatment depends on the aetiology and there are different therapeutic options, from conservative to more or less invasive surgical interventions. Among the latter is nucleolysis or percutaneous disc decompression by laser (PLDD), which consists in the percutaneous approach of the intervertebral disc for performing the denaturation, by vaporization, of the nucleus pulposus using laser energy.

In the lumbar region pain reduction has been observed in 60-89% of patients operated by PLDD; however it is necessary to emphasize the high percentage of failure of the technique, which sometimes requires that up to 38% of successfully treated patients to be intervened again by conventional surgery. The failure due to the impossibility of performing the PLDD has been reported in several studies by 9%. In the cervical and thoracic location, an improvement of the symptoms is indicated between 54.5-83% at 24 months of follow-up. Although PLDD is a minimally invasive treatment, it does not mean that complications cannot emerge, studies of the lumbar region report the appearance of muscle spasm (7.7%), sacroiliac inflammation (4.5%), transient nerve root damage (5%), recurrences (1.5%) and discitis (1.2%). In addition, bleeding, bruising, new-onset root deficit and damage to the sigmoid artery have also been observed.

Laser spine surgery for spinal stenosis

Spinal stenosis is the narrowing of the bone canal through which the spinal cord runs and often does not cause any problem. However, in some cases, it is progressive and comes to compress the nerve roots, which causes intense pain in the leg. It is the most frequent reason for back surgery between over 65 years.

Unlike the antiquated “open” back surgery, there is laser spine surgery, which does not require hospitalization because it is minimally invasive, allowing patients to experience much less trauma. Patients who undergo this surgery can return to work and start their daily activities a lot more quickly than patients who have had “open” back surgeries.

Laser spine surgery is aimed at increasing the space for spinal nerves by shring bulging discs that may be impinging on nerves.

The technique uses a needle to deliver laser energy into the disc.

About laser in medicine

The meaning of the laser in medicine grows continuously. The introduction of the most modern multi-channel systems at the beginning of the new century revolutionized medicinal laser therapy, since highly focused lasers (‘laser needles’) imply a deep penetration and also with the combination of different laser wavelengths (red laser, infrared, green and blue) various restorative effects on the tissue are achieved.

Thanks to the consequent research and technical improvement, lasers can now be applied directly into damaged tissue, to allow more effective treatment in disorders that do not react to traditional therapies (damage to the spine, hernias, osteoarthritis, etc.).

The use of intravenous laser therapy entails a general energization, an optimization of the metabolism and a reinforcement of the immune system and therefore offers a successful possibility of treating numerous painful diseases resistant to traditional therapies.

With the laser needles, the emergent beam is configured and penetrates the tissue with its energetic light particles and can radiate in damaged tissue in the depth. Thanks to the high energy concentration and the treatment periods, a proven reaction can be achieved with excellent success in the treatment of pain.

What is a Facet Joint Injection ?

Facet joint injection consists of placing a local anesthetic (medicine to numb an area) with a steroid (an anti-inflammatory medicine) in a facet joint of the dorsal column. The facet joints are located between the vertebrae. There are 2 facet joints between each pair of vertebrae. These joints give stability while allowing the spinal column to bend and turn. The use, wear, and old age can make these joints hurt a lot.

What is the purpose of this injection?

The goal is to relieve pain so you can return to perform your normal daily life activities unless your doctor tells you otherwise. In most cases, you can also do physiotherapy again.

What happens during the intervention?

The patient remains awake during the entire intervention. Blood pressure, heart rate, and breathing are continuously monitored. With the patient lying face down on the intervention table, the site of the injection is cleaned with an antiseptic. In this procedure, a needle passes through the skin, muscle and soft tissues, thus causing some discomfort for the patient.

A little anesthetic will be injected to numb the place where you are feeling pain. This intervention takes around 30 minutes.

What medicines are used in this intervention?

  • Lidocaine or bupivacaine are local anesthetics that are used to numb the site of the injection. Numbness usually disappears between 2 and 6 hours after the intervention.
  • Steroid medication such as Triamcinolone or depo-medrone is used commonly to treat inflammation and pain. The benefits of this steroid can take up to 10 days to appear.

Are there any risks of spinal injections ?

Spinal injections are very useful to control pain. Risks related to this procedure are rare when performed by a specialist.

Possible risks of epidural steroid injections

Some potential risks have been linked with lumbar epidural steroid injections. In conjunction with the temporary numbness of intestines and bladder, the most frequent risks and complications are the following: 

Infections: Infections are very rare, they occur in 0.1% to 0.01% of injections.

Dural puncture (“wet tap”): A dural puncture arises in 0.5% of injections. It can cause a headache after the lumbar puncture, which can improve after a few days. Although it is not very frequent, a blood patch may be necessary to relieve a headache. A blood patch is a medical procedure that consists in injecting a small amount of blood into the epidural space around the spinal canal, close to the area of the previous puncture. As the blood clots, it forms a “patch” that seals the site and stops the leak of cerebrospinal fluid.

Bleeding: Bleeding is an unusual complication and it prevails in patients with underlying bleeding disorders.

Nerve damage: Although it is very infrequent, it may arise from direct trauma from the needle, infection, or bleeding.

Possible side effects of lumbar epidural steroid injection

Along with the mentioned risks from the injection, there are also possible side effects of the steroid medication itself. These are extremely uncommon and their prevalence is much lower than the side effects of oral steroids. However, reported side effects of epidural steroid injections include: Localized increase in pain, non-postural headaches that resolve within 24 hours, facial flushing, anxiety, insomnia, fever (the night of the injection), hyperglycemia (high blood sugar), a transient decrease in immunity due to the suppressive effect of steroids, stomach ulcers, severe hip arthritis (avascular necrosis) and cataracts.

What are the signs of infection in the spine?

Spinal infections are rare but can occur in your body allows the entry of bacetria through the skin, longs, urine, ears or other entry points.

The clinical presentation is similar in the pyogenic and granulomatous processes, and the patient will present according to the stage of the process, which is basically

1. the presence of pain

2. secondary paravertebral muscle contracture

3. functional limitation

4. Progressive deformity of the spinal axis due to kyphosis or kyphoscoliosis,

5. possibility of variable neurological damage

6. General state of unwellness manifested by anorexia, asthenia (abnormal physical weakness),  weight loss, and fever, which can sometimes be of the low-grade type and predominantly vespertine.

In case of a pyogenic process it has a sharper and more florid presentation.

The penetration of a pathogenic germ occurs in the body through a defect of the protection mechanisms. The survival of germs depends on their ability to achieve successive access to the lymphatic and subepithelial tissues. When the bacteria circulate, although they are not associated with clinical manifestations, a bacteremia occurs, and if a favorable response of the reticuloendothelial system arises on the part of the host, the control of the germs will occur.

If the infection spreads, septicemia may arise. This assumes that germs and their toxins are in the bloodstream. Toxemia represents rather the state of the circulation of toxins than of germs through the bloodstream.

Many spinal infections occur as a result of seeding hematogenous bacteria from distant sites.

Currently there is a wide variety of organisms involved in spinal infection. Staphylococcus aureus is the most frequent cause of pyogenic osteomyelitis of the spine, and Staphylococcus epidermidis is also a frequent cause of infection. Among the gram-negative enteropathogens we have Escherichia coli, Proteus mirabilis, Enterococcus and others that are frequent in patients immunocompromised or postoperative. Pseudomonas aeruginosa is common in intravenous drug users.

Brucellosis is caused by a capnophilic coccobacillus, common in those that live with animals or those that process milk or meat, with frequent lumbar affection that resembles degenerative processes.

Fungal infections of the spine include Aspergillus, blastomycosis, coccidioidomycosis, and cryptococcosis.