[annapurna]

I recognize your concerns about pain killers. As you're obviously active on the internet, you might want to investigate studies that show that controlled use of pain killers strictly as needed to moderate pain is unlikely to lead to addiction. I don't want to twist your arm on this as you'll have to decide what's acceptable for your life but an approach is to moderate the pain to enough degree that you feel able to think and plan. Certainly, I can't imagine your depression being resolvable by any means if you're in constant pain from your back and know that there's no potential for it improving. Temporary use of low levels of pain killers might help you feel like there's a way off the merry-go-round.

To go beyond that advice, you mention that you have a degenerated L5S1 but say the degeneration has progressed further. Do you mean that you have multiple levels involved or that L5S1 has gotten worse? Single level replacements with fusion, especially at L5S1, can work and are much easier to argue for in the US.