Dear Doctor: I've had lower back pain for years, and nothing has helped. I’ve tried physical therapy, yoga and chiropractors, and I’ve even contemplated surgery. My sister suggests something called the Alexander technique. What do you think? I'm willing to try anything, but I don't want to chase after treatments that aren’t useful.

Dear Reader: When our ancient ancestors stood up and became bipeds, they gave humans a crucial evolutionary advantage. They also left us with another lasting legacy -- back pain. It’s a near-universal complaint, and it ranks among the largest contributors to disability throughout the world. Yet, because the spine is a complex structure, the specific causes of back pain often remain elusive. This can make finding an effective treatment both difficult and frustrating.

The majority of back pain affects the lower back, which supports much of the weight of the upper body. The most common causes of pain in the region are the mechanics of how we stand and move, injuries to the tissues and structures of the back and spine and, often, a combination of the two. Poor posture, poor alignment and the ergonomics of the tools and objects in our daily lives all play a role. Put too much stress or torque on the spine, and you’re at risk of injuries to the muscles, ligaments, tendons and nerves in the region.

A back injury can make itself known suddenly, as with a muscle spasm or a slipped disc, or may emerge over time. Either way, the pain and disruption can be daunting. Yoga, physical therapy and chiropractic care can indeed lessen lower back pain, and we’re sorry to hear that none of these approaches brought you relief. Massage, acupuncture and mindfulness exercises also can help. Some of our patients living with lower back pain have had success using topical heat, as well as over-the-counter creams, gels and patches.

All of which brings us -- at last! -- to your sister’s suggestion, the Alexander technique. It’s a series of posture lessons that focus on alignment, balance, breathing, coordination, spatial awareness and the release of tension, particularly in the neck, shoulders, spine, back and hips. Developed in the 1890s by Frederick Matthias Alexander, the technique has been used for chronic back pain, arthritis and Parkinson’s disease. In this method, students relearn how to sit, stand, walk, bend, reach and move, all with an awareness of gravity’s downward pull. A single session may focus solely on the proper alignment for rising from a chair, or it may be spent lying on the ground methodically assessing and releasing areas of tension.

Classes typically are one-on-one, carried out by a certified teacher who observes the student and guides them with both verbal explanations and gentle, hands-on adjustments. Several studies have confirmed the benefits of the Alexander technique for back pain, including one published in the journal BMJ. In that study, researchers found that one-on-one lessons with a certified teacher had long-term benefits for patients with chronic back pain. We recommend the Alexander technique to our own patients who are dealing with back pain. If lessons are available in your area, we think this approach to dealing with lower back pain is worth exploring.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I’m worried about my best friend. She seems overwhelmed taking care of her elderly parents as well as her own family, but she won’t admit it. How do I know if she’s in trouble?

Dear Reader: There’s a name for the rapidly increasing number of Americans who find themselves in your friend’s position of caring for older parents while raising a family -- the sandwich generation. They account for a significant chunk of the estimated 43 million adults in the United States who act as unpaid caregivers to aging parents or relatives. And when the scope and stress of the duties they’ve taken on become too great, many put the needs of loved ones ahead of their own well-being. Among cooking, cleaning, shopping, errands, homework help, extracurricular activities for their own families and managing similar tasks, plus medical appointments for an aging or ailing relative, personal welfare often falls by the wayside. This includes no longer spending time with friends and engaging in personal interests, and neglecting their careers, medical care, and mental and spiritual health.

There’s no question that being a caregiver can be rewarding. When you pitch in to help an aging parent, relative or friend, you enhance that person’s quality of life. Often, this unpaid care allows older adults to remain in their own homes. Much of the help involves emotional support, and many caregivers report a deepening of their relationships with the people they’re helping.

But the role of caregiver is often complicated. It can be difficult for both parties to navigate the change of roles when a child becomes a parent’s guardian. An aging parent’s escalating lack of control over his or her own life can be frightening, and the parent can grow demanding and even unreasonable. This becomes even more of a challenge when someone has cognitive problems, as with dementia and Alzheimer’s disease.

You're correct that the demands of caregiving can be overwhelming. They often lead to fatigue, apathy, anger, depression and, eventually, burnout. Signs of this include withdrawal from family, friends and activities, as well as feelings of loss, worthlessness or hopelessness. There may be changes to sleep and mood; changes to weight; abuse of alcohol or drugs, which includes prescription medications; and a lack of interest in self-care.

To prevent burnout, it’s important for caregivers to make time each day for themselves. Even a half-hour for a solo walk, a dive into a magazine or a novel or to chat with a friend can help to ease stress. It’s also important to be willing to ask for help, and to be specific. Make a list of tasks for friends and relatives who want to lend a hand, such as shopping for groceries, handling a doctor’s visit, taking a pet to the vet or doing some housecleaning.

A support group for caregivers is a great place to share experiences, vent, meet new friends and learn about support services. Speaking of which, you’ll find very good suggestions at the AARP website (AARP.org) and the U.S. Department of Health & Human Services website (HHS.gov). Just put the words “caregiver resources” into the search box.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello, dear readers, and welcome back to our monthly letters column. We’re happy to report that you’ve kept our mailboxes full, so we’ll dive right in.

-- Pet-related topics always get a lot of mail, and a recent column about a study into the health benefits of living with a dog was no different. A reader from Tulsa, Oklahoma, wrote to say that limited mobility need not be a barrier to canine companionship. “People who are physically unable to walk a dog outdoors can experience the joy provided by a pet and the other benefits of pet ownership, particularly with a small breed,” she wrote. “They can be trained to use potty pads indoors. We recently adopted a 3-year-old rescue Chihuahua who quickly learned to use the potty pads. As I write this, my current ‘favorite child’ is right here beside me. Life is just better with a pet in your lap.”

-- A reader from Coeur d’Alene, Idaho, who volunteers at a local hospital with her therapy dog, wrote to say she sees the happiness that a dog imparts with every visit. “It’s refreshing to read about how dogs make a difference in the healing process. I witness that emotion every time we visit,” she wrote. “And, as you pointed out, the nurses, doctors and support staff all love interacting with the dogs as well."

-- In response to a column about carpal tunnel syndrome, a reader from Fresno, California, found that a small tweak to his work habits made a big difference to the severe carpal tunnel pain he experienced while using a mouse during computer work. “I went to several doctors, but ultimately decided to just move the mouse to the left side of the keyboard,” he wrote. “It was awkward for about a week, but eventually I adapted, and after two months, the pain was gone.” Since then, he switches hands on the first day of each month and reports, “my carpal tunnel pain has never returned.”

-- A column about the flu that mentioned that symptoms can be similar to those of a bad cold left a reader in Spokane, Washington, confused. “All my life -- 62 years -- the flu has been referred to as an illness with symptoms such as fever, stomach upset or vomiting, lack of appetite, diarrhea and achiness, and it seems to take longer to get well from than a cold,” he wrote. “Have I been confused about what flu really is?” To clarify, the flu is an infection of the influenza virus. It typically shares respiratory symptoms with the common cold, and can cause the additional symptoms that you mention. The diagnostic difference between the flu and a cold is the virus that causes each infection. And, as you mention, the flu lasts longer than a cold and tends to be more severe.

That’s it for this month. Thank you again for all of your questions, tips, comments and kind words. We love hearing from you. And just a reminder to new readers -- we can’t make a diagnosis, recommend medications or offer a second opinion.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)