<s>[INST] I have lower back pain, my mri report said minimal disk bulging at l3-4 is seen impinging upon the thecal sac. mild degenerative disk disease is seen and l3-4, l4-5 with signal alteration. facet degenerative changes at l3-4, l4-5 and l5-s1.  the dr  who I sent my mri to (a va dr). had his nurse call me and told me to quit complaining, there was nothing wrong with my lower back. the va dr never saw me or ask me any questions.. what can I do to lower my pain levels, as they affect my everyday living. I can and do receive pain meds at my local hospital. dont tell me about shots in the lower back (over 30 times)cant do that any more. [/INST] Hi and thank you so much for trusting us with your health query. I am so sorry to hear about this persistent pain. If the current doctor would not attend to your repeated concerns about this pain, I will suggest that you get a second opinion from another physician. Besides, your pain medications should be titrated to a level that permits a pain free life to improve the quality of your live. This can be done with powerful medications. Also try physical therapy, and get a neurosurgeon consult to evaluate for the possibility of surgical management. I hope you find this helpful. Thank you so much for using our services, and please feel free to for more information or clarifications if need be. I wish you the best of health. </s>