Doctors Increasingly Ignore Evidence In Treating Back Pain

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Source: Alcorn Public Radio, by The Editor
Date: July 30, 2013The misery of low back pain often drives people to the doctor to seek relief. But doctors are doing a pretty miserable job of treating back pain, a study finds.

Physicians are increasingly prescribing expensive scans, narcotic painkillers and other treatments that don’t help in most cases, and can make things a lot worse. Since 1 in 10 of all primary care visits are for low back pain, this is no small matter.

What does help? Some ibuprofen or other over-the-counter painkiller, and maybe some physical therapy. That’s the evidence-based protocol. With that regimen, most people’s back pain goes away within three months. [Or much faster with a Mumanu Pillow]

But when researchers at Beth Israel Deaconess Medical Center in Boston looked at records of 23,918 doctor visits for simple back pain between 1999 and 2010, they found that doctors have actually been getting worse at prescribing scientifically based treatments.

Doctors were recommending NSAID pain relievers and acetaminophen less often. Instead, they were increasingly prescribing prescription opioids like OxyContin, with use rising from 19 percent of cases to 29 percent. Over-the-counter painkiller use declined from 37 percent to 25 percent. Other studies have found that opioids help only slightly with acute back pain and are worthless for treating chronic back pain.

“That’s a big public health issue,” says Dr. John Mafi, chief medical resident and a fellow at Beth Israel Deaconess. Mafi was the lead author of the study, which was published online in JAMA Internal Medicine. In the 1990s doctors were criticized for ignoring patients’ pain, Mafi says. Some of that criticism was valid, but doctors have overreacted. “What magic bullet better than a very powerful pain medication?”

About 43 percent of patients taking opioids for chronic back pain also had other substance abuse disorders, the researchers found. In 2008, almost 15,000 people died from overdoses of prescription opioids, and abuse has surged among women. Opioids may be necessary in some cases, Mafi says, but “they’re certainly not first-line.”

Doctors were also quick to whip out the prescription pad and call for CT and MRI scans for people with lower back pain, the study found. The number of people getting scans rose from 7 to 11 percent. Though those scans won’t hurt the patient, in most cases they don’t find anything wrong. And they are expensive, costing $1,000 or more.

Patients are partly to blame for the rush to scan, Mafi says. “Patients are expecting very comprehensive evaluations,” he tells Shots. “There’s a sentiment perhaps if my doctor ordered an MRI for my back pain they really listened to me. It’s almost validating.”

And in an era when doctors are rated online by patients, “doctors have an incentive to make patients happy,” Mafi says.

Financial incentives for doctors may also be a factor. This study didn’t examine why doctors aren’t following clinical guidelines for treating back pain, but other studies have found that when doctors own imaging equipment, they are more likely to use it.

Doctors should be cut a little slack, a journal commentary accompanying this study says, because guidelines have been conflicted on back pain treatment until recently, and it takes 17 years, on average, for new treatment standards to be widely adopted. But creating checklist-type guidelines for doctors would help speed that process, the commentary says. So would requiring patients to pay more of the cost of expensive imaging, and providing payment incentives for doctors who do the right thing.

“For the majority of new-onset back pain [cases], it gets better within three months,” Mafi says. “Unfortunately, we don’t have fancy treatments that cure it.” Time, some ibuprofen and gentle exercise aren’t sexy. But they most often do the trick.

Copyright 2013 NPR. www.npr.org

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Therapeutic massage more effective than acupuncture or self-care education

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Source: News Fix, by April Clarkson
Date: 19th July 2013Researchers from the Group Health Cooperative, US, report the results of a study which found that therapeutic massage was more effective than other complementary therapies for persistent back pain, and apparently provides long-lasting benefits.The researchers randomised 262 patients with persistent lower back pain, aged between 20 and 70 years, to receive either acupuncture (n=94), therapeutic massage (n=78), or self-care educational materials (n=90). Up to 10 massage or acupuncture treatments were allowed over a 10-week period. Telephone interviewers scored patients for symptoms and disability after four, 10, and 52 weeks.

The researchers found:

  • At 10 weeks, massage was superior to self-care on both the symptom and disability scale
  • Massage was superior to acupuncture on the disability scale
  • After one year, massage was no better than self-care, but was better than acupuncture on both scales
  • The massage group used the least medications and had the lowest costs of subsequent care.

The authors noted that Traditional Chinese Medical acupuncture seemed relatively ineffective, and suggested that massage may be a useful alternative to conventional medicine in the treatment of persistent back pain.

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Why do you sit me up?

Source: Moverse en Libertad
26 may, 2013 by adminfreeimage-2155693-highI never liked the idea of sitting up babies early in life. In the beginning my reasons were more related with musculoskeletal issues, specifically to avoid stress in bones and joints that are still developing and consequently not prepared to support weight. Today I still advocate against sitting up babies but my reasons have changed, and now I think more about emotional and cognitive development, sensory nutrition, and growing up as active human beings. Let me explain further.

fuente autobiografia.blogspot.com

Sitting up our babies early in life is not a new practice in our society. Back in the 1950s the paediatrician Emmi Pikler already described how unnatural this common practice was and how those babies who were exposed to that posture early in their life showed a completely different posture in comparison to those babies who were raised up following the freedom of movement concept. She found that those babies were more likely to be tense and look as they had “swallowed a broomstick”. This kind of muscle tension is an understandable reaction to an unbalanced situation where the trunk is expected to keep a vertical position even though it has not had much time exercising antigravity muscles in previous postures such as tummy time (when the baby is rolling by himself). Thus, adults impose a posture that the baby is not able to achieve on his own and, in consequence, interfere with the normal developmental sequence of that child.

A couple of years ago, I did a lecture in Chile about the “Freedom of movement and Emmi Pikler’s approach” to physiotherapists, early childhood teachers, and students. I asked: When do children sit up by themselves? There was a range of answers: some of them said between 4 and 5 months, others said 6 months and some said 8 months. The only clear thing about the answers was that it was not clear at all. To answer this question, we need to start by asking if we all have the same understanding of what it means to “sit up”.

I can sit!

We need to analyse what we mean by “sitting up”, because there are significant differences between keeping that posture and reaching that posture. Let’s examine this further. When a baby manages to keep sitting up when an adult puts him in that position, it is because he has experienced this posture several times and is able to sort out the imbalance and keep the position. Nevertheless, if that baby falls over, he is not able to regain the position on his own. On the other hand, when sitting up is a posture that babies build from their own motivation and sensorimotor resources derived from exploring with their bodies, it does not require practice or teaching and is part of a chain of milestones that are inherent in our genes as a species. In general, a baby sits up by his own after rolling, twisting, and crawling, and this usually happens around nine months.

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Therefore, respecting the developmental process of our babies means that we support and encourage their self-motivated exploration and avoid listening to the comments of other adults who will not hesitate to judge this practice as delaying our child’s development. From my professional and personal experience, I truly believe that a child who is not made to sit up by an adult in his early days and is, to the contrary, able to explore the world at his own pace, is a baby who will develop active movement earlier. He will be able to roll and become aware that if he rolls two times he can get something he likes, so he will be ready to move around a long time earlier than starting to crawl or walk. At the same time, and as a direct consequence of not being put in a position he is not able to keep, we have a child who feels secure and content in his own body and builds the awareness of active embodiment in space. As a result he develops more and more complex relationships with his environment and becomes an active explorer of the world.

When a child is made to sit up by an adult early in life, his exploration abilities are restricted by the imbalance and he will probably need constant assistance during his play; someone who will give him the toys and also give them back when they fall from his hands. Moreover, he will probably complain more often, reacting to what happened in his environment. A baby who explores from his own motor abilities will not need this constant assistance as he is able to do things by his own or is flexible enough to change his mind if he is not able to reach something he wants. That is probably why Emmi Pikler called one of her books “Peaceful babies, contented mothers”.

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In addition, if a baby is made to sit up early, his legs become a static part of the posture rather than being active as in rolling or crawling, skipping some very important milestones in his life. This lack of activation contrasts with the active and flexible legs of a baby who moves around, and a brain which is receiving constant sensory information from muscles, joints, touch and vestibular system. As a result, the baby who is in movement will have a more complex map of his body in his brain.

fuente www.waldorftoday.com

We could go on with many more reasons about why we should avoid sitting up our babies early in life, but perhaps another important thing we should keep in mind is… What is the rush? If we think about how much time this baby will spend sitting in his life, it will probably, similar to our own experience – i.e., too much time. So again, what is the rush?…better to give them the opportunity to actively discover the environment that surrounds them. As adults, we do not need to teach them how to move, we just need to trust in their own abilities and observe them unfold their full potential.

*Many thanks to David Moore from The School for FM Alexander Studies in Melbourne who generously edited my first translation.

Do You Have Sciatica Hip Pain?

Man suffering from sciatica
Source: Low Right Back Pain HQ
Photo from Boots.com
23rd May 2013The largest nerves found in the human body are the sciatic nerves. Measuring approximately the same size in diameter as a little finger, the nerves exit the spinal column in the lumbar region, travel behind the hip and continue down through the buttock and the back of each leg to the foot. The length and size of the nerve creates a host of symptoms unique to sciatica hip pain.

Sciatica Symptoms

Unlike common lumbar pain, sciatica hip pain typically begins toward the hip region and travels down the affected leg, sometimes down to the foot. Depending on the impingement, the pain varies from annoying to disabling. The sensation ranges from tingling or burning to a deep, sharp shooting pain. The painful sensation often originates or worsens with movement or position changes that include standing from a sitting position. Coughing, laughing, sneezing or having a bowel movement often also intensifies pain.

Some individuals also might experience pain in one region of the leg and numbness in another. Some may experience a weakening in the leg or foot accompanied by sciatica hip pain. The weakness may become so severe that mobility becomes difficult.

Sciatica Causes

The discomfort begins when the nerve sustains compression or irritation. The pain may begin suddenly after lifting a heavy object or moving quickly. Sciatica hip pain also begins when various physiological changes occur.

Herniated or slipped discs remain the most common contributing factor. The discs lie between each vertebra and consist of a tough exterior and a gel like interior. Approximately the shape and size of a common checker, the discs provide shock absorbing cushioning. If the outer covering of the disc ruptures, the gelatinous interior oozes through the disc and compresses the sciatic nerve.

Spinal stenosis often occurs during the normal aging process and involves a narrowing of the vertebral space that surrounds the spinal column. The excess bone applies direct pressure to the sciatic nerve. People suffering from spinal stenosis often experience bilateral sciatica or discomfort radiating toward both hips.
Other aging factors that contribute to the condition include osteoarthritis or fractures caused by osteoporosis.

Spondylolisthesis refers to the condition involving a vertebra shifting out of place and over the adjoining vertebra, which compresses the sciatic nerve.

Piriformis syndrome describes the circumstance when the sciatic nerve becomes pinched or trapped by the piriformis muscle of the buttock.

Though rare, blood clots, systemic infections or tumors might also create the condition.

Seek Medical Attention

Individuals suffering sciatica hip pain should seek medical intervention under the following circumstances:

* Symptoms persist longer than three days or become progressively worse.
* Anyone younger than 20 or older than 55 experiencing sciatica for the first time.
* If currently diagnosed with cancer or have a history of cancer.
* If recently experiencing severe weight loss, unexplained chills or fever accompanied by back pain.
* Have a diagnosis of HIV positive.
* Use IV drugs.
* Experience difficulty bending forward for more than one or two weeks.
* Unexplained and increasing leg weakness.
* Inability to feel sensation or move the legs or feet.
* Unbearable pain not relieved by OTC medications or other first aid treatments.
* The pain occurs after a traumatic injury.
* Experience numbness in the genital region, lose bladder or bowel control.

Home Treatment

Avoid positions that increase pain. Lie on your back with a Mumanu support pillow under the knees, or assume a side lying position with a Mumanu support pillow [under the top leg] to maintain hip alignment. However, remaining immobile for extended periods of time often exacerbates the condition. Take OTC anti-inflammatory medications per label instructions unless contraindicated if also taking prescription blood thinning medications. Apply an ice pack to the area. Alternate using ice packs with moist, warm heat. You may also check out these [stretches for sciatica]

Researchers Study the Cycle of Chronic Back Pain and Depression

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Source: Nature World News.com by staff reporter
Apr 22, 2013Depression and chronic pain in the lower back often reinforce each other, according to a researcher from Australia. People with back pain are more likely to be depressed and people who are depressed can’t cope with pain.

The key in fighting this type of a pain-cycle is to stop it in its earliest stages. The study was conducted on a group of 300 patients who were receiving treatments for their back pain.

“The important thing is that doctors act quickly and do not wait for more severe symptoms to develop. Patients might not need anti-depressants; a variety of other treatments such as relaxation, biofeedback and cognitive behavioural therapy could help,” professor Markus Melloh from Western Australian Institute for Medical Research (WAIMR) said in a news release.

The study also included researchers from University of Berne in Switzerland. Researchers found that study participants who had symptoms of depression at the beginning of the treatment also had higher back pain scores after three weeks.

Also, participants who had back pain after three weeks were more likely to have signs of depression.

“Knowing about the reciprocal relationship between depression and back pain can make a real difference in the effectiveness of treatments for patients,” said Melloh.

The study is published in the journal Psychology Health & Medicine.

About 350 million people in the world suffer from depression, according to data from the World Health Organization.

Sleep Well, Live Well… Suffering from back pain? The Mumanu relieves lower back and hip pain while you sleep. www.mumanu.com

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Recent Research Questions the Effectiveness of Back Surgery

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Source: San Francisco Chronicle, Sturgeon Bay, WI (PRWEB) May 29, 2013

An estimated 38 to 50 billion dollars is spent yearly for the surgical treatment of lower back pain in the United States. While this is commonly accepted as the price to pay for this debilitating condition, Chiropractor and Naturopath Dr. J G Moellendorf examines two recent research studies and a neurosurgical university’s health policy questioning surgery’s effectiveness and cost.

Many victims of chronic low back pain turn to surgery when the muscle relaxers, anti-inflammatories, and pain killers fail. Considering the recent research, Sturgeon Bay, Wisconsin Chiropractor and Naturopath Dr. J G Moellendorf, DC, ND, LCP questions whether less costly alternatives to very expensive spinal surgeries might be a better solution.

A research team led by Dr. Benjamin J Keeney looked at workers compensation injuries in the state of Washington to determine if it could predict which work injuries would result in back surgeries. Their results were published in the May 15, 2013 issue of the journal Spine titled Early Predictors of Lumbar Spine Surgery After Occupational Back Injury: Results From a Prospective Study of Workers in Washington State. Out of 1,885 injured workers, 174 (9.2%) had low back surgery within 3 years of injury. The researchers discovered that if an injured worker was first seen by a surgeon, 42.7% would result in surgery, while if first seen by a Chiropractor, only 1.5% had surgery. The rate of an expensive surgery was reduced by 96.5%, just by the choice of the first doctor consulted.

Dr. Anne Froholdt’s research group at the Oslo (Norway) University Hospital followed chronic low back pain patients across a nine year period. Participants were randomly assigned to two groups. The first group had lumbar spinal fusion, while the second received cognitive training on doing daily activities without worrying about further injury, along with endurance and coordination exercises. Publishing their results in the December 2012 issue of the European Spine Journal, they found that during the nine years studied, of those who had spinal surgeries, one-third were operated on again. Of those in the non-surgery group, one-third opted to have surgery done. There were no notable differences in daily rated pain intensity, fear-avoidance beliefs, spinal muscle strength, and use of medication between the two groups. Both groups reported significantly less back and leg pain, less fear-avoidance beliefs, less emotional distress, and improved general function. Sixty-eight percent of those having surgery were out of work, while only forty-two percent of the non-surgery group were not working. Forty-four percent of the lumbar fusion group used medications for pain compared to seventeen percent in those who did not have surgery. Seventeen percent of those having surgery were dissatisfied with their results compared to only three percent among those who did not have surgery.

Dr. J G Moellendorf, DC, ND, LCP asks, “Why would we spend billions of dollars yearly on spinal surgery that has no better results than conservative therapies, while having increased disability rates and higher dissatisfaction with results?”

Realizing the high failure rate and heavy costs of back surgery, the University of Pittsburgh Medical Center (UPMC) health plan analyzed recent research for treating chronic low back pain. On January 1, 2012, UPMC implemented a comprehensive clinical initiative focused on the treatment of chronic low back pain. All lower back surgeries other than surgical emergencies require prior determination for surgical necessity. The policy states:

“To be considered for surgery, patients with chronic low back pain must have:

“This policy was developed using evidence-based literature and professional society guidelines, as well as the input of external medical professionals with expertise in the area”

Only Half of Hip, Knee Surgeries Successful

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Source: newsmaxhealth.com By Nick Tate
Friday, 05 Apr 2013Only half of arthritis patients who undergo hip or knee replacement report a significant improvement in pain and mobility, according to a study that raises new questions about the effectiveness of such procedures.

The research, led by Women’s College Hospital and the Institute for Clinical and Evaluative Sciences, is based on an analysis of 2,400 patients with osteoarthritis and inflammatory arthritis in Ontario. Nearly 480 had a hip or knee replacement and, of the 202 patients included in the study, only half reported a meaningful improvement in pain and disability one to two years after surgery.

What’s more, researchers found the patients who had worse knee or hip pain to begin with but fewer general health problems were more likely to report benefits. Nearly 83 percent of the patients had at least two troublesome hips and or knees.

“Many patients with hip and knee arthritis have the condition in more than one of their hip or knee joints,” said Gillian Hawker, M.D., who led the study, published in the journal Arthritis & Rheumatism. “So it’s not surprising that replacing a single joint doesn’t alleviate all their pain and disability — patients may need subsequent surgeries to maximize the benefits of joint replacement.”

Arthritis is a leading cause of disability in men and women. Joint damage from osteoarthritis is responsible for more than 80 percent and 90 percent of hip replacement and knee surgeries, the researchers noted. About 25 percent of patients who undergo a single joint replacement will have another joint replacement — usually the other hip or knee — within two years.

“While demand for joint replacement surgery has increased as our population ages, physicians lack a set of established criteria to help determine what patients will benefit from surgery and at what point during the course of the disease,” said Dr. Hawker, physician-in-chief at Women’s College Hospital and a senior scientist at ICES. “As physicians, we need to do a better job of targeting treatments to the right patient at the right time by the right provider.”

© 2013 NewsmaxHealth. All rights reserved.

8 Types of Low Back Pain that Mean You Should Visit Your Doctor

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Source: advancingyourhealth.org by Susan Dreyer, MDOver 80% of the population will suffer from lower back pain at some point in their lives. Low back pain is a common complaint in medical offices and is a common issue causing many people to miss work and be unable to participate in daily life activities. Sometimes back pain is due to a pulled or strained muscle and many times will not require a trip to your doctor’s office. Other issues such as fractures, tumors and infections of the spine are very serious and need to be evaluated by a physician promptly.Patients should see a doctor immediately if they experience low back pain as a result of severe trauma. Patients should also make an appointment with a doctor if low back pain is accompanied by any of the following: fever, loss of bowel or bladder control, serious trauma, numbness, unplanned weight loss, personal history of cancer, back pain that persists more than 6 weeks, or severe night pain.

Fever and Back Pain
Fever combined with back pain can indicate an infection in your kidneys or back. A primary care physician can determine if you need antibiotics to eliminate the infection.

Loss of control of your bowel or bladder and Back Pain
If you have back pain along with new incontinence, you could have a serious back condition causing pressure on the nerves that requires immediate medical care.

Serious Trauma and Back Pain
Trauma such as a car accident or falling down a flight of stairs can cause a fracture in your back. Seek immediate care from your physician or the emergency department.

Numbness or Tingling in Leg and Back Pain
Numbness on tingling in your leg and back pain could indicate nerve irritation or nerve damage. You could have a herniated disc or spinal stenosis. A doctor can prescribe medications, treatments or even surgery to help relieve the pressure on the nerves.

Unexplained weight loss and Back Pain
If you lose a lot of weight without changing your diet or activity level and have back pain, a doctor should order imaging and blood work to check for cancers or hormonal disorders.

History of Cancer and New Back Pain
If you have had cancer, onset of back pain could be a sign that cancer has spread to you spine. You should visit your physician for further evaluation.

Back Pain at Night
Pain in your back that causes you to lose sleep should not be dismissed. This could be a sign of spinal tumors or even cancer.

Back pain that lasts more than 6 weeks
Any pain that lasts more than a month or two should be evaluated more fully.

If you experience significant trauma and back pain, an evaluation in the Emergency Department is indicated. In most other cases, your primary care physician can evaluate your condition and begin treatment. . If he or she is unable to help with your condition he can refer you to a spine specialist.

Dr. Susan Dreyer
About Susan Dreyer, MD
Dr. Dreyer is an Associate Professor in the departments of Orthopaedics and Physical Medicine & Rehabilitation at Emory University School of Medicine. Dr. Dreyer specializes in non-operative spine care and focuses on helping patients achieve their best functional level. She has taught many national and international courses on spine care and spinal injections for sciatica and other causes of back and neck problems. She is also active in several professional societies. Dr. Dreyer started practicing at Emory in 1992.

The most comfortable pregnancy sleeping position to relieve lower back & hip pain

Sleeping well is so important during pregnancy to have you feeling full of energy and refreshed for the day ahead. Most pregnant women get uncomfortable during the night and as a result find it difficult to sleep well.

TOP TIP: The pillow between the knees is an urban myth. It puts too much pressure on the bottom leg, the knee joint twists which then twists the hip joint and pulls on the lower back. Sleeping with the pillow in foetal position further pulls on the buttocks and lower back muscles and if not supported correctly makes your spine twist. The pillow between your knees also puts pressure on your bladder so more getting up in the night. You also reduce space for your baby which means more kicking.
The Mumanu pillow relieves these problems by keeping your hip, knee and foot at the same height. It’s self-inflating so you adjust it to fit you perfectly. This position allows you to fully relax, takes pressure off your bladder and gives your baby extra space to be comfortable.

The hormone Relaxin makes your joints loser during pregnancy so it’s even more important than normal to get correctly aligned and super comfortable.
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To relieve that pulling, heavy feeling in your belly, place a contoured pregnancy belly wedge under your belly to gently lift and bring your pregnant bump up to a neutral position.
Mumanu pillow range
You can purchase the Original Mumanu Pregnancy Pillow and the Mumanu Memory Foam Contoured Pregnancy Belly Wedge by visiting www.mumanu.com

6 Tips for Avoiding Back Pain During Sex

6 Tips For Avoiding Back Pain During Sex
Source: YourTango, by Connie Merk, March 26, 2013For people with lower back pain, just the thought of sexual activity can induce fear instead of excitement. Sex is supposed to be pleasurable, but when it’s associated with physical pain, sexual activity stops. And when that happens, relationships suffer.

The most important advice I can give, not only as someone who is working with back pain patients all the time, but also as someone who suffered from back pain for many years, is to be open with your partner. Communication prevents tension and misunderstandings.

Your partner needs to understand that you haven’t lost your interest in him or her, but that you are afraid of aggravating your pain. Your partner needs to feel that you still love him. Otherwise, your condition could jeopardize your relationship.

Openness is key. Talk about what works for you and what doesn’t — for both of you. It is not just the position that matters. Having sex is more than a performing act. Lovemaking is about closeness, sharing, understanding, pleasure, fun, and orgasm.

There are plenty of ways people can find sexual fulfillment besides penetration. If you’ve never experimented with oral sex, sex toys, different positions, now is the time! Get creative and explore. You may find that your sex life suddenly becomes much more interesting and fun.

Here are some more useful tips:

1. Prepare well. For many people, sex is something that happens spontaneously, and thus they believe that any kind of planning makes it less valuable or less enjoyable. But nothing could be further from the truth.

When you are dealing with acute or chronic back pain, proper preparation for “the act” may be the only way to enjoy the experience. Nothing kills passion faster then a sudden onset of pain or the constant fear that the wrong movement will render you helpless on the bed.

Due to your constant pain, it may be difficult for you to relax and let go. Thus, trying to relax the affected muscles by taking a muscle relaxant or pain killer might help to prepare for the sexual encounter. Or, even better, have your partner join you in a warm bath or hot shower, or give you a gentle massage as part of your foreplay.

2. Try different positions. Plan exactly where to have sex and in what position in order to avoid pain. In the beginning, you might need to try out different positions until you find the right one for you and your partner, where you both can be comfortable.

Try preparing the room with cushions, towels and covers under the knees, head, or lower back for support. Remember, it is all about feeling relaxed so you can enjoy your lovemaking.

If it is the man who suffers from back pain, you may want to try lying on a firm surface and using pillows to support the knee and/or head. A small, rolled towel under the lower back may bring additional comfort. You could also sit on a chair with a back rest and have your partner straddle you.

If it is the woman who suffers from back pain, the missionary position with the legs bent toward the chest may be worth trying out. Sitting on the edge of a chair with your partner kneeling between your legs is also a position that works for many woman. Or, have your partner sit on a chair while you sit on his lap, facing away from him.

Finally, regardless of who suffers from back pain, a side-by-side position may be the best. Both partners should on their sides, she with her back to him. Then, he can enter from behind, which is normally a very comfortable position for both.

3. Don’t rush. Plan your sexual encounter with your partner so that you have all the time in the world. Enjoy what you are doing. Maybe you were never too much into foreplay. If so, now is your chance now to explore that part of lovemaking and get to know your partner in a new, sensual way.

Choose sensuality over sexuality as you may not be as vigorous as you once were.

4. Undress first. As I have said before, when dealing with back pain, thoughtful preparation goes a long way, and not just when it comes to your position. In the throes of passion, we are not necessarily paying attention to anything besides our sensations.

We definitely don’t pay attention to our bodies and how they move. Therefore, undress carefully. You don’t want to struggle to get your clothes off in an awkward position that may knock your back out.

5. Masturbation, oral sex and sex toys. If penetration is too painful for one of the partners, there are plenty of other ways to give your partner sexual pleasures. Oral sex, masturbation and dildos or vibrators are great ways to bring about sexual fulfillment and spice up your sex life.

The most important thing is to communicate openly about what you both like and don’t like, and to explore and experiment with new ways of giving and receiving pleasure.

6. Make sex fun. If you are up for it, why not bring some spice into your bedroom? Try playing doctor.

The more you are distracted from your back pain, the better. Sex raises the spirit and puts you in a better mood. Plus, having an orgasm also relaxes all the muscles in the body, and if your muscles are relaxed, your will feel less pain.

With a bit of preparation and fantasy, suffering from back pain does not mean that you are doomed to a life without sex. On the contrary. You could find that experimenting with longer foreplay, toys, positions and role-plays —things you would have never considered before — can actually spice up your sex life. Just be open with your partner, and have fun!

Mumanu, not just a sleeping pillow! This fabulous pillow is self-inflating so adjust the height to your own comfort. (This position is not recommended from 30 weeks pregnant.) Visit the website for more ways to use the Mumanu

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