What Is Back Pain?

                     

Lower back pain (lumbago) is not a disorder. It’s a symptom. It usually refers to a problem with one or more parts of the lower back like:

• ligaments
• muscles
• nerves
• the bony structures that make up the spine (vertebral bodies)

It can also describe pain caused by a problem with nearby organs, like the kidneys or lungs.

According to the American Associate of Neurological Surgeons, 75 to 80 percent of Americans will experience back pain in their lifetime. Fifty percent of those will have more than one episode. Although it can be painful, in 90 percent of all cases, the pain goes away without surgery. Talk to your doctor if you are experiencing back pack.

Understanding the Back

To understand the causes of lower back pain it helps to understand the back. Your back is composed of many parts, including:

• the spine
• muscles
• tendons
• ligaments
• nerves
• blood vessels

The lower spine is one of the keys to low back pain. It’s made up of:

• the bones of the lower spine (lumbar and sacral vertebrae)
• disks of cartilage between the vertebrae
• nerves and your spinal cord
• muscles and ligaments that hold it together

What Causes Back Pain?

The most common causes of lower back pain are strain and problems with back structures.

Strain

Strained muscles and ligaments often cause back pain. Strain commonly occurs with incorrect lifting of heavy objects and sudden awkward movements. Strain can also result from over-activity. An example is the sore feeling and “stiffness” that might occur after a few hours of yard work or after playing a sport.

Structural Problems

Vertebrae are the interlocking bones stacked on top of one another at the back of the torso or trunk of your body. Disks made of cartilage cushion the area between each vertebra. Disk injuries are a fairly common cause of back pain.

Sometimes these disks can bulge (herniate) or rupture. Nerves can get compressed when this happens. Herniated disks can be very painful. A bulging disk pressing on the nerve that travels from your back down your leg can cause sciatica or irritation of the sciatic nerve. Sciatica can be experienced as a pain, tingling, numbness, or weakness in the leg.

Abnormalities of the skeleton can also cause back pain. This includes scoliosis or narrowing of the spinal canal due to arthritis.

Loss of bone density and thinning of the bone (osteoporosis) is very and can lead to fractures in your vertebrae. These fractures can cause serious pain and are referred to as compression fractures.

Other Causes of Back Pain

There are many other potential causes of back pain, but most of these are rare. Be sure to see your doctor if you experience regular back pain that does not go away. After ruling out the more common causes of back pain, your doctor will perform tests to determine if you have a more rare cause. These can include:

• narrowing of the spinal canal (spinal stenosis)
• displacement of one vertebral body onto another (degenerative spondylolisthesis)
• loss of nerve function at the lower spinal cord (cauda equine syndrome)
• fungal or bacterial infection of the spine (typically Staphylococcus or E. coli)
• cancer or non-malignant tumor in the spine

What Are the Characteristics of Back Pain?

Back pain can have many symptoms including:

• a dull aching sensation in the lower back
• a stabbing or shooting pain that can radiate down the leg to the foot
• an inability to stand up straight
• a decreased range of motion and diminished ability to flex the back
•  

The symptoms of back pain, if due to strain or misuse, are usually short-lived but can last for days or weeks. Back pain is chronic when symptoms have been present for longer than three months.

Back Pain Symptoms That May Indicate a Serious Problem

The Mayo Clinic recommends you see your doctor if back pain does not improve within the first 72 hours of self-care. There are times when back pain can be a symptom of a serious medical problem. Symptoms that can indicate a more serious medical problem are:

• loss of bowel or bladder control
• numbness, tingling, or weakness in one or both legs
• onset following trauma such as a fall or a blow to the back
• intense, constant pain that gets worse at night
• presence of unexplained weight loss
• pain associated with a throbbing sensation in the abdomen
• presence of fever

Risk Factors For Back Pain

You are at an increased risk for back pain if you:

• work in a sedentary environment. Going from a sedentary workplace to high-impact activity can lead to back strain.
• are of older age
• are female
• are obese
• are a smoker

Studies show that your emotional health also has an effect on your risk for back pain. You are at a high risk for back pain if you have a stressful job or suffer from depression and anxiety.

How Is Back Pain Diagnosed?

A physical exam is typically all that’s needed to diagnose back pain. During the physical exam, your doctor will test the range of motion of your spine and your ability to sit, stand, and walk. The doctor may also test your reflexes, leg strength, and your ability to detect sensations in your legs.

If a more serious condition is suspected, your doctor might order other tests. These might include:

• blood and urine tests to check for underlying conditions
• X-rays of the spine to show alignment of your bones and check for breaks
• computed tomography (CT) scan or magnetic resonance imaging (MRI) to assess your disks, muscles, tendons, ligaments, nerves, and blood vessels
• bone scan
• electromyography (EMG) to test nerve conduction

Treatment

Medication

The majority of back pain episodes are relieved by treatment with nonsteroidal anti-inflammatory medications like aspirin, ibuprofen (Motrin), or naproxen (Aleve). Pain relievers (analgesics) like acetaminophen (Tylenol) are also an option. Except for acetaminophen, these medications should be taken with food because they can irritate the stomach and cause it to bleed.

If back pain is severe, your doctor may prescribe medications that contain a narcotic such as codeine. Low-dose amitriptyline, a tricyclic antidepressant, can also relieve back pain.

Your doctor might recommend cortisone steroid injections for severe back pain. Pain relief from steroid injections lasts no longer than a few months. The body builds up immunity to the effects of cortisone.

Home Remedies

Ice packs may relieve discomfort and help lessen inflammation in acute phases of back pain. Warm compresses may relieve pain when inflammation has subsided.

Exercises to improve posture and strengthen the muscles of the back and abdominal muscles (core muscles) are a treatment option that should be strongly considered. Improving posture, using proper lifting techniques, and having muscles help to prevent recurrences.

Surgery

Surgery is a treatment of last resort and is rarely needed for back pain. It’s usually reserved for structural abnormalities that have not responded to conservative treatment, severe, unremitting pain, and nerve compression that cause muscles to become weak.

Spinal fusion is a surgery in which painful vertebrae are fused into one single, more solid bone. It helps eliminate painful motion of the spine.

Surgery to partially remove and replace disks and vertebrae may be done to relieve pain caused by degenerative bone diseases.

Alternative Medicine

According to the Mayo Clinic, devil’s claw (Harpagophytum procumbens, a plant in the sesame family) and willow bark (Salix alba) taken orally and capsicum (Capsicum frutescens, chili pepper) plaster applied topically may relieve low back pain. These herbs are known to have anti-inflammatory properties.

Other alternative therapies include:

• acupuncture
• massage
• chiropractic adjustments
• cognitive behavioral therapy
• progressive relaxation

Be sure to talk to your doctor before undergoing any alternative or complementary treatment. 

What Do You Want to Know About Birth Control?

                                                     

Birth control, also known as contraception, can help prevent an unwanted pregnancy until you are ready to have a baby. Some forms of birth control also help protect you from a sexually transmitted disease (STD).

There are many different types of birth control and no single method is right for everyone. It’s important to consider the pros and cons of each type of birth control and select the one most suited to your needs and lifestyle. Think carefully about how easy it is to use and if you are comfortable using it. You will also want to consider if and when you are planning to have children.

Other important questions to consider when choosing a birth control method include:

• Does it contain hormones?
• Does it protect against sexually transmitted diseases (STDs)?
• Does it require a visit to a doctor or a prescription from a doctor?
• Does it require preparation right before sex?
• Is it quickly reversible?
• Is it easy to use and will I remember to take it?
• Does it decrease monthly bleeding and cramping (females)?
• Is it noticeable and do I want my partner to be aware that I am using it?
• Is it safe?
• Am I allergic to any of its components?
• Does it have side effects and how long will they last?
• Will it affect my sex drive/sensation during sex?
• How effective is it?
• How much does it cost?
• Am I willing to pay a lot more now if the method lasts for a long time?
• How often do I have to take it?

What Types of Birth Control Are Available?

Some methods of birth control work better than others. The following is a list of the various types of birth control available, sorted by how effective they are at preventing pregnancies.

Extremely Effective (99-100%)

• abstinence: Abstinence is complete avoidance of sex.
• intrauterine device (IUD): This is a small, T-shaped piece of plastic that is put inside a woman’s uterus by a doctor. There are two kinds. A copper IUD releases a small amount of copper to prevent sperm from fertilizing an egg. The complete mechanisms of action of hormonal IUDs are not completely understood. There are several different types available, all of which release small amounts of hormones into the uterine cavity. Some of the methods by which this inhibits conception include thickening of the cervical mucus to prevent sperm penetration, alteration of the uterine lining to make it inhospitable for a fertilized egg to implant, and also, in some cases, partially suppressing the release of eggs from the ovaries (ovulation).
• implants: An implant is a soft plastic rod that is placed just under the skin of your arm by a doctor. The rod releases a synthetic progestin hormone over three years. Its primary mechanism of action is to prevent eggs from being released from the ovaries.
• sterilization: This is a permanent method of birth control that involves cutting or blocking the tubes that carry sperm (in men) or the tubes that carry eggs to the uterus (in women).

Very Effective (>91%)

• shot: This is an injection of a progestin hormone which is slowly absorbed by your body and prevents any eggs from leaving your ovaries. Each injection works for approximately 12 weeks, so it’s extremely important to receive subsequent injections on schedule if you wish to maintain contraception.
• patch: This is a small sticky patch worn on the skin that sends steady levels of hormones into your bloodstream.
• vaginal ring: This is a soft, plastic ring that you put in your vagina, where it releases a steady dose of sex hormones.
• birth control pills: This is a set of pills usually taken every single day at the same time, which contain hormones called estrogen and progesterone. The pill works by stopping the release of eggs from your ovaries.

Effective (>80%)

• condoms: This is a thin, disposable wrap placed over the erect penis. If used correctly, sperm will be trapped inside the condom and will not be able to get inside the vagina
• cervical barriers (diaphragm, cap, or shield): A cervical barrier is a small rubber cup that you fill with spermicidal jelly and place in your vagina, over the cervix, before sex. This prevents sperm from entering your uterus.

Moderately Effective (>70%)

• spermicides: These are chemicals that come in the form of jellies, creams, or foams that kill sperm. They are usually used together with a cervical barrier, such as a diaphragm.
• sponge: This is a small foam pad soaked in spermicide and placed in the vagina over the cervix.
• fertility tracking: This method involves very carefully tracking changes in your body so you can know when you are most likely to be fertile and when you are not. You are not likely to get pregnant if you have sexual intercourse on the days you are not fertile.

Emergency Contraceptives

Emergency contraceptive pills are used to prevent pregnancy after you have already had unprotected sex (sex without using a birth control method). They are sometimes called the “morning after pill.” They may be used as a backup if your normal birth control method fails or you forget to take it.

Emergency contraceptives can prevent pregnancy for up to five days after sex. They will not work if you are already pregnant.

Ineffective Forms of Birth Control

These methods are not a reliable form of birth control:

• douching
• urinating after intercourse
• feminine hygiene products
• home-made condoms

What Are the Pros and Cons of Each Type?

All methods of birth control, including the emergency contraceptive pill, have been carefully tested and are considered very safe. However, every method has its advantages and disadvantages.

Abstinence

Pros:

₋          There are no health risks.

₋          It’s completely free.

Cons:

₋          It requires self-control and offers no protection if you change your mind and decide to have sex. You should always have another birth control method nearby.

₋          You can still get STDs from oral sex or skin-to-skin contact, such as rubbing each other’s genitals.

Intrauterine device (IUD)

Pros:

₋          It lasts up to 12 years (copper IUD) or up to five years (hormonal IUD).

₋          You do not have to interrupt or stop sex to use it.

₋          It is completely undetectable during sex.

Cons:

₋          It does not protect against STDs.

₋          It requires insertion by a doctor.

₋          The cost up front is high ($500 or more).

₋          It may cause irregular bleeding or spotting.

₋          It is possible to get an infection when the IUD is inserted (this is rare).

Implants

Pros:

₋          It is effective for up to three years.

₋          It is convenient and private.

₋          The cost up front is high ($400 or more).

Cons:

₋          It must be inserted and removed by doctor who has had special training.

₋          There’s the possibility of infection at the site of insertion.

₋          It does not protect against STDs.

₋          Periods will change and bleeding may become irregular.

Sterilization

Pros:

₋          It’s permanent and is a good choice for men or women who do not want any more children.

₋          You do not have to interrupt or stop sex to use this method.

Cons:

₋          It does not protect against STDs.

₋          It requires surgical procedure by a doctor.

₋          The cost up front is high if you don’t have health insurance.

₋          It is irreversible, so you must be absolutely certain that you don’t want any more children before you decide to take this stop.

₋          It carries typical surgery risks.

Shot

Pros:

₋          You only have to get it four times a year (every 12 weeks).

₋          The effects wear off after the 12-week period.

₋          It reduces the risk of endometrial cancer.

₋          You do not have to interrupt or stop sex to use it.

₋          No one can tell that you are using it.

₋          After a few shots, many women will stop having periods altogether. This is safe.

Cons:

₋          It does not protect against STDs.

₋          It requires a doctor visit.

₋          It may cause irregular bleeding or spotting.

₋          It may decrease the strength of your bones since it lowers your body’s natural estrogen levels.

Patch

Pros:

₋          It’s easier to use than birth control pills and only needs to be changed once a week.

₋          You do not have to interrupt or stop sex to use it.

Cons:

₋          You need to remember to change it every week.

₋          It requires a prescription from a doctor.

₋          It does not protect against STDs.

₋          It may cause irregular bleeding or spotting.

₋          It should not be used if you have a blood clotting disorder.

Vaginal Ring

Pros:

₋          It may clear up acne.

₋          Periods may be more regular, lighter, and less painful.

₋          You do not have to interrupt or stop sex to use it.

₋          Reversible.

Cons:

₋          It does not protect against STDs.

₋          It requires a prescription from a doctor.

₋          It should not be used if you have a blood clotting disorder.

₋          You must insert and remove it every month.

Birth Control Pills

Pros:

₋          It’s a reversible form of contraception.

₋          They reduce menstrual cramps.

₋          They make periods regular and lighter.

₋          They reduce acne.

₋          They lower risk of ovarian and endometrial cancer and ovarian cysts.

₋          There are many different types available.

₋          It has a low monthly cost ($10-$50) and may be covered by your health insurance.

Cons:

₋          They do not protect against STDs.

₋          They may interfere with other medications you are taking.

₋          They can cause minor side effects and mood changes, but these should go away after the first few months.

₋          They should not be used by smokers above the age of 35 or by people who have blood clotting disorders.

₋          You MUST remember to take it every day at the same time.

₋          They require a prescription from a doctor.

Condoms

Pros:

₋          They can be purchased over the counter at a drugstore or grocery store without a prescription.

₋          They protects from STDs.

₋          They are inexpensive. You may be able to get them for free at a family planning clinic.

Cons:

₋          Some people are allergic to the latex or liquid used to package the condom.

₋          You have to interrupt sex to put the condom on.

₋          Some men or women do not like to wear them because it decreases or changes sensation during sex.

₋          Condoms are not effective it they break or rip during sex.

Cervical Barriers

Pros:

₋          They do not use hormones.

₋          They are reusable.

₋          They protect against certain STDs.

₋          A barrier can be inserted 24 hours before sex so you do not have to interrupt or stop sex to use it.

Cons:

₋          You need to plan ahead and insert the barrier properly up to 24 hours before sex.

₋          Barriers can dislodge during sex.

₋          They may cause vaginal discharge and odour.

₋          Some people are allergic to the material or the spermicide used with the barrier.

₋          They require fitting by a doctor and a prescription.

Spermicides

Pros:

₋          They can be used by women who smoke or breast-feed.

₋          They may provide lubrication during sex.

₋          They can be bought over-the-counter at a drugstore or grocery store without a prescription.

₋          They do not contain any hormones and will not change your periods.

Cons:

₋          They do not protect against STDs.

₋          They may cause allergic reactions in some people or irritation if used more than twice a day.

₋          You may have to interrupt sex to use a spermicide.

Sponge

Pros:

₋          It can be bought over the counter at a drug store or grocery store without a prescription.

₋          It is easy to insert and can be used for a 24-hour period, during which you can have sex multiple times.

₋          No chemicals or hormones.

Cons:

₋          It does not protect against STDs.

₋          Some people are allergic to the spermicide in the sponge.

Fertility Tracking

Pros:

₋          There are no health risks.

₋          No hormones or chemicals will enter your body.

Cons:

₋          You will need to learn from a trained expert how to check and record your body signs for this method to work.

₋          It requires keeping a daily record (there are also electronic devices and mobile calendars or applications to help keep track of changes).

₋          It does not protect against STDs.

₋          This is only an option for women who have regular periods.

How Do I Choose the Method That’s Right for Me?

Figuring out which method to use can be a bit overwhelming. A method that’s perfect for one woman may not be right for another.

Take a moment to consider all of the important questions and all of the available options. Then weigh the pros and cons of each option as it applies to your own lifestyle and future plans. You may even decide to use a combination of birth control methods for extra protection against pregnancy and STDs.

You can always talk to a doctor or to a clinic that specializes in family planning to help you choose a method that is right for you. The more you know, the more in control you can be of your sexual health as well as when you may want to have children.