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

### input:
my 73 year old partner has chronic pain from an (operable, with a year wait list) back condition that affects his shoulder and legs. he has been reduced to being barely able to walk. he has tried hydro morph, fentanyl, and a host of other pain killers and none have had any effect on even reducing the level of his pain. in the past and for various conditions he has shown himself resistant to medications. an acupuncture treatment has been the only effective treatment so far but we live 1500 miles (southeast Yukon) from an acupuncturist. in Kelowna last year he was given an epidural and even that did not ease his pain. what other, if any, alternatives are there? we are getting desperate.

### output:

There are quite a long list of other therapies for the pain. The operation issue intrigues me because the shoulder and the back are not connected. And the shoulder if it is the part down below the neck is inside the chest and doesn't get much wear and tear. If it is at the neck, then neck disk disease is very, very common and almost always shows up on regular x-rays. BUT. Has nothing to do with back and legs in the vast majority. Back to pain management: There are multiple levels. Obviously the first level is what is broken and fixing it with the surgery. The second level is the pain produced from the problem. Nerve pills sometimes work. Muscle relaxants sometimes work. Amitriptyline is both a nerve pill (like lidocaine) and a blocker of pain signals at the spine. The third level is the context in which the pain is held. While lately everyone is talking about mindfulness and yoga, frankly you might as well try a fidget spinner. I am highly dubious about all of them. BUT, having the pain be directed by oneself and having it decrease is known to be among the MOST effective modulators of pain. So, if you can do exercise or physical therapy in the context of MAKING IT PAINFUL, then the pain experience is less after creating the pain and with repeating it the pain goes down (except during the physical therapy where it goes up for the first 2 months then stabilizes but is still painful).