### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I was diagnosed just over a year ago with an L5/S1 annular tear and after trying nearly everything I m no further along. Since day one though the symptoms have never fit together. Dull stabbing pain is clear as day in that S1 area but the radiating pain doesn t fit and I believe I may also be dealing with pinched nerves. Standing causes medial foot pain in the heel and numbness in the toes, especially the right foot and big toe. Occasionally I feel shooting pain under my left testicle as well. Any quick movement or resistance causes upper body trembling. Pushing through my abdomen as if I m straining to pee causes my lower back to tremble. My lower back behind my abdomen, and the abs themselves get on fire after awhile from standing, sitting, activity, ...basically anything. Often times I feel pain behind the ribs, especially the left side, maybe where the trigger points are? Every day I wake up and rush to get what I can done before lunch when I m forced to lay down with a heating pad and 5 mg of Oxycodone-Acetaminophen. I do the same until dinner and then one more time before bed. If I sit straight up with good posture or stand my L5/S1 fires up, and if I hunch and/or sit my lower back is on fire. Its not livable and nothing has worked. PT, chiropractic, epidurals, etc. I m trying to journal daily with as much detail as possible but how do I even know who to check with? I d like to see someone who can look at the total kinesiology and figure out the cause as well as a solution. Fusion surgery has been mentioned by the Spine Dr. but I feel that is but one of the issues and not the source itself. At least not completely.

### output:

Hi, I passed carefully through your question and would explain that your symptoms could be related to the chronic degeneration on your vertebral column and the pressure on the nerves.  For this reason, I would recommend physiotherapy and trying Gabapentin or Pregabalin for the pain. Another treatment option would be amitriptyline. You should discuss with your doctor on the above treatment options.  Hope I have answered your query. Let me know if I can assist you further. 