How old are you? Male or female?
Since when is this pain?
Have you tried physical therapy?
What are the other modalities you have tried?
Are you overweight, smoker or take alcohol?
The low back has the following comprehensive management principles:
1) Back care in the activities of daily living is one of the most significant part of the treatment. Back education and back school will tech you to handle your back: It teaches the patient basic body mechanics, such as the correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into a car, and sitting in a car. Back school also teaches patients the proper and improper behaviors when their back is painful in case they have to sit, bend forward, lie down, cough, or sneeze.
a) Avoid activities which increases the pain.
c) Avoid bending at 90 degrees
d) Pushing and pulling should be avoided till pain subsides
f) Avoid prolonged sitting and standing
g) Avoid sitting or sleeping on floor
2) Anti-inflammatory analgesics like ibuprofen, analgesics and muscle relaxants
3) Local analgesic gels or sprays
4) Hot fomentation
5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by Physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.
6) Good supervised physiotherapy: Floor exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises are some of the best activities for back pain.
7) Lumbosacral corset or support
8) Epidural steroid shots
9) Surgery last resort
10) If obese reduce weight
I can understand, with your age and associated knee and hip osteoarthritis, physical therapy is difficult. But all specialists agree that it is mainstay of the treatment.
Degenerative disc disease is not life threatening, however it can certainly impact the quality of one's life due to pain and changes in activity that may occur. This disease is increasingly common as we age. Obesity, heavy lifting and smoking also increase the rate of occurrence or difficulty in complete pain relief.
Of all connective tissues, the intervertebral disk undergoes the most serious age-related changes. This cascade of degenerative changes can be subdivided into 3 stages: dysfunction, instability, and restabilization. Dysfunction involves outer annular tears and separation of the endplate, cartilage destruction, and facet synovial reaction. The dysfunction stage is followed by the instability stage, in which disk resorption and loss of disk space height occur. In the stage of restabilization, the progressive degenerative changes lead to osteophyte formation and stenosis. The symptoms are low back pain of varying severity. The signs are muscle tenderness, stiffness, reduced movement, and scoliosis.
Transforaminal selective nerve root blocks have been used as both subjective diagnostic and therapeutic interventions for lumbar spinal stenotic levels. When MRIs show evidence of multilevel degenerative disk disease, Selective Nerve Root Block can be used as a tool to try to determine if a specific nerve root is affected. Surgery may be the other option, in which they remove the herniated disc. This relieves the pressure from the pinched nerves and thus pain.
Feel free for your follow up questions.
I forgot to mention;
1) A trial of another steroid shot can still be done for your this residual pain.
2) After that you can go for your hip replacement.
Post operatively you can have physical therapy for hips and back together.
You are always welcome.