Q: I am a 72-year-old female who happens to love golf, but my neck and back pain is starting to prevent me from enjoying this activity. For as long as I can remember, I have been in pain. Some 30 years ago, I was diagnosed as having degenerated disks in my lower back.

About a year ago, I began experiencing arm and elbow pain. An MRI confirmed pinched nerves at C-5-6. Pain management has only taken me so far; I have received cortisone shots for both my back and arms. They did nothing to ease my back and the relief in my arms and elbows was minimal. I have had a trigger-point injection and chiropractor treatment also. All of these things combined have left me very frustrated and my pain is getting worse. I am looking for some direction as to where I might go from here. I am not looking to have surgery.

Are there any less invasive techniques that you could suggest that I might look into? Any help or suggestions that you can give me would be greatly appreciated.

-- Marge W.

A: I feel your frustration from your question and hope I can provide some information and perhaps some help. It is clear that you have tried various treatment options to help with your problem. All of these interventions have been reasonable and it is unfortunate that they haven't worked out well for you. That said, I am not sure how well they have been implemented and whether the things you have done were part of a cohesive treatment plan.

Pain management can be effective for patients whose pain does not improve with time and regular non-narcotic medications such as anti-inflammatories. However, pain management is more than just injections. Pain management should include counseling, therapy and also medications. It is not clear if all these other parts were used in your case or that you were simply given injections.

Chiropractic treatment and other forms of manipulative therapy can be very effective for both back and neck pain. Often times these treatments are combined with medications and activity modifications. Other "alternative" treatments that can be considered include acupuncture and bracing. Another less invasive treatment that has been used for low back and neck pain is traction.

There are commercially available systems, one is called VAX-D which is proposed to work by placing traction across the back and therefore taking pressure off the nerves.

In the same way that not all patients will benefit from surgery, not all patients will benefit from these different treatments described above. It is very important for your doctor to do a through evaluation including physical examination and for your doctor to order the appropriate studies (X-rays and MRI).

It is from this evaluation that the proper treatment, whether it be chiropractic treatment, medications, injections or surgery, can then be prescribed.

The opinions expressed are solely those of the writer. Dr. Dwight Tyndall is a practicing Spine Surgeon. He can be reached at dstyndall@yahoo.com (use the subject line "bone doctor column"), www.spinecarespecialists.com or at Dr. Dwight Tyndall, 730 45th St., Munster, IN 46321. This column is intended for informational purposes only. Readers should seek specific medical advice from their own physician.