How can I manage painful feet and worsening back pain from degenerative spine disease that makes walking to the dining hall difficult while staying in temporary housing?

Managing Severe Back and Foot Pain from Degenerative Spine Disease

You need immediate MRI imaging and urgent neurosurgical evaluation to rule out progressive nerve compression, especially given your severe walking limitations and new or worsening symptoms. 1

Immediate Red Flag Assessment

Your inability to walk to the dining hall represents a critical functional impairment that requires urgent evaluation. The American College of Physicians recommends immediate MRI of the lumbar spine for new-onset or worsening leg symptoms in the setting of chronic degenerative changes, as this represents a red flag for progressive neurological compromise that may require surgical decompression. 1

Key symptoms requiring urgent evaluation include:

• Progressive leg numbness or weakness 1
• Radiating leg pain in a specific nerve distribution 1
• Leg pain and weakness with walking or standing (neurogenic claudication) 1
• Any bowel or bladder dysfunction (medical emergency) 1

Conservative Management Algorithm

If imaging shows no urgent surgical indications, proceed with this structured approach:

First-Line Treatment (6-12 weeks minimum)

Structured physical therapy is mandatory before any surgical consideration. 2 The American College of Neurosurgery requires comprehensive conservative management including formal physical therapy for at least 6 weeks to 3 months. 2

• Core strengthening and flexibility exercises focusing on lumbar stabilization 1
• Aerobic conditioning within pain tolerance 1
• General and instrument-based exercises have shown 1.5-point pain reduction on numeric scales 3

Medication Management

Start duloxetine 60 mg once daily for chronic musculoskeletal pain. 4 FDA-approved trials in chronic low back pain demonstrated statistically significant pain reduction, with some patients experiencing relief as early as week 1. 4

• Duloxetine 60 mg once daily is the optimal dose (120 mg showed no additional benefit with more side effects) 4
• Add gabapentin or pregabalin for neuropathic/radicular symptoms 2, 1
• NSAIDs for anti-inflammatory effect 1
• Up to 4 grams acetaminophen daily as needed 4

Adjunctive Therapies

Whole-body cryotherapy combined with kinesitherapy may provide additional benefit. A series of 10 treatments showed 1.5-point pain reduction and 0.8 cm improvement in lumbar flexion mobility. 3

Surgical Indications

Refer to spine surgery if you meet these criteria: 1

• Progressive neurological deficit (weakness, numbness worsening) 1
• Severe or intolerable symptoms despite 3-6 months comprehensive conservative management 2, 1
• Documented spinal stenosis with spondylolisthesis on MRI 1
• Significant functional impairment affecting quality of life (inability to walk to dining hall qualifies) 1

Surgical outcomes are superior when appropriate criteria are met. Decompression with fusion for stenosis and spondylolisthesis shows 93-96% excellent/good results versus 44% with decompression alone, with statistically significant improvements in back pain (p=0.01) and leg pain (p=0.002). 2

Critical Pitfalls to Avoid

• Never delay imaging when new neurological symptoms develop—attributing symptoms to "normal aging" can lead to permanent nerve damage 1
• Epidural steroid injections provide only short-term relief (less than 2 weeks) and do not satisfy conservative treatment requirements 2
• Facet injections are contraindicated if you have radiculopathy (leg pain/numbness) 1
• Do not proceed to surgery without completing formal physical therapy—this is a critical deficiency that makes surgery medically unnecessary 2

Immediate Action Plan

1. Request MRI of lumbar spine to evaluate neural compression 1
2. Obtain neurosurgical consultation if MRI shows stenosis or nerve compression 1
3. Start duloxetine 60 mg daily for chronic pain management 4
4. Enroll in formal physical therapy program (minimum 6 weeks) 2, 1
5. Use assistive device (walker or cane) to prevent falls if you have weakness 2

The combination of severe functional impairment (inability to walk to dining hall) with degenerative spine disease warrants aggressive evaluation and treatment, but surgical intervention requires documented nerve compression on MRI and completion of comprehensive conservative management first. 2, 1