The no--or the yes and the how--of sex for patients with neck, back and radicular pain syndromes.

The restrictions imposed upon sexual activity by neck, back and radicular pain syndromes are of serious concern to the patient. In recent years the subject of When, and even How is raised with increasing frequency, and the patient expects the physician to reply with appropriate answers. The reply must be tempered by the level of the patient's recovery, the evaluation of what other activities the patient can perform without pain or with minimal pain and the method to be used. Sexual activity may precipitate recurrent pain or aggravate existing pain in the same manner as lifting, pushing, pulling or any other physical activity, if performed too early or too vigorously in the course of recovery from neck, back or radicular pain syndromes. In dealing with the problem of recovery from painful musculoskeletal or neuromuscular states, timing is of the utmost importance. Unless a timetable is specifically outlined, recurrences are common, and the condition may become chronic. The inability of the patient to deal satisfactorily with the sexual aspect of his daily living may, in itself, lead to emotional tensions and guilt feelings which may delay or prevent recovery. There is need to handle this problem at every level of the involvement in order to achieve a desirable end result-namely, the absence of pain and its replacement with pleasure.