The following is a modern tragedy.

Once a tall, strapping man, he is now in his 70s and terribly out of condition. He has a remarkably round belly that hangs way over his belt, but he has no backside. His wife says that it's amazing he finds a way to keep his pants up. He's diabetic, hypertensive, has coronary disease and has had angioplasty twice in the last 10 years. For these conditions, he is supposed to take more than 15 pills a day, and, on top of all of that, he is depressed.

But this story is about his back pain. It started after a work-related accident in his 40s, and he had back surgery four or five years ago, which helped at first. But little by little, the pain has returned big time, and he said that it's the reason he has not been able to get out of the chair, let alone exercise.

Many doctors have seen him for this pain, several in my clinic and in the other clinic in town. He's been to multiple clinics in Sioux Falls, and off and on to a number of the chiropractors.

Lately, our patient has been receiving injections into his back.

He had five in just the past month, to no avail. The steroids in the injections, however, made his diabetes worse.

He has spent a fortune on CT scans and MRIs of his back, all of which indicate an aging arthritis with plenty of abnormalities. This year, he has been to several surgeons, and all have rightly refused to do more surgery. He's still searching for help.

There are three take-home lessons in this story:

• It's very likely he would not be in pain now if he had stayed in shape, starting when he was younger.
• Our existing health care system has not been able to help him, even though the cost has been enormous. As a country, we need to make changes to avoid such expensive and ineffective care.
• There is hope for this man, but it comes not with more surgery and pain pills, but rather a rehab plan for a gradual return to activity, while learning to live with and push through some of that pain.

This should not have to end in tragedy.

Dr. Rick Holm is the host of "On Call," a weekly call-in program about health on South Dakota Public Broadcasting that is produced by the South Dakota Cooperative Extension Service. "On Call" airs at 6 p.m. Thursdays. Holm has practiced general internal medicine and geriatrics in South Dakota for more than 20 years.