Q: Seven years back a MRI showed that I had a herniated disc at L4-L5. Steroid shots and lorcet every 6 months helped me for 5 years but my back pain has been increasing a lot. I just had another MRI this year that showed disc dessication at L4-L5. What can I do for the pain?

A:The following general measures will help decrease your low backache. The way a person moves, stands, or sleeps during the day plays a major role in back pain: 1. Maintaining good posture is very important. This means keeping the ears, shoulders, and hips in a straight line with the head up and stomach pulled in. It is best not to stand for long periods of time. If it is necessary, walk as much as possible and wear shoes without heels, preferably with cushioned soles. Using a low stool, alternate resting each foot on it. 2. Sitting puts the most pressure on the back. Chairs should either have straight backs or low-back support. If possible, chairs should swivel to avoid twisting at the waist, have arm rests, and adjustable backs. While sitting, the knees should be a little higher than the hip, so a low stool or hassock is useful to put the feet on. A small pillow or rolled towel behind the lower back helps relieve pressure while either sitting or driving. 3. Riding, and particularly driving, for long periods in a vehicle increases stress. Move the seat as far forward as possible to avoid bending forward. The back of the seat should be reclined not more than 30° and, if possible, the seat bottom should be tilted slightly up in front. For long rides, one should stop and walk around about every hour and avoid lifting or carrying objects immediately after the ride. 4. Be sure to have a firm mattress. If the mattress is too soft, a 1/4-inch plywood board can be put between the mattress and box spring. On the other hand, some people have experienced morning backache from a mattress that is too hard. The back is the best guide. Tips for Lifting and Bending Anyone who engages in heavy lifting should take precautions when lifting and bending: 1. If an object is too heavy or awkward, get help. 2. Spread your feet apart to give a wide base of support. 3. Stand as close as possible to the object being lifted. 4. Bend at the knees--not at the waist. As you move up and down, tighten stomach muscles and tuck buttocks in so that the pelvis is rolled under and the spine remains in a natural GENERAL APPROACH FOR TREATMENT OF BACKACHE For treating short-term acute low back pain, the best results derive from the least aggressive treatments. The general approach is the following: 1. Patients with no indication of any serious underlying cause should stay as active as possible within the limits of the back pain. (Bed rest is not recommended.) Some studies suggest that a third of patients with uncomplicated low back pain are significantly improved after a week with no other treatment than normal activity and two thirds have recovered by seven weeks. 2. Physical therapy or spinal manipulations may be helpful if pain continues for more than two to three weeks. 3. The patients should seek a specialist if pain continues for more than a month (or less than this if there are indications of an underlying disorder, nerve damage, or injury). 4. Back pain attributed to medical conditions, such as arthritis, osteoporosis, or pregnancy, either resolves when the condition does or is treated as part of the overall therapeutic plan.