Physical medicine doctor eases chronic back and leg pain

In the early 2000s, Matthew had four surgeries on his back — including two fusions to stabilize his spine — three operations on his abdomen and one on his elbow. Now 52, he never expected to face so many serious health issues as the new millennium began.

Many of those surgeries were successful, but the Apache Junction resident still battles chronic nerve damage and back pain today. What helped Matthew the most with those issues was a referral in 2016 to Amber Hennenhoefer, DO, an HonorHealth physical medicine and rehabilitation physician.

"She reduced the amount of opioids I was taking and the accompanying brain fog," Matthew said. "It felt like a godsend. She was able to bring back some clarity to my life and my thought processes."

'I felt something in my lower back go'

His back problems began in his 30s while earning his master's degree in restoration ecology at Arizona State University-Polytechnic.

"I was on a field trip on the Mogollon Rim for a habitat management class involving big game elk," Matthew remembers. "We were recovering radio collars that had fallen off deer and elk. I tried to climb up a log retaining wall when I felt something in my lower back go. My internist told me it was the biggest disk herniation he'd ever seen when he saw my MRI. There was also another bulging disk."

A laminectomy to remove material leaking out of the lower disk relieved pressure on his spinal nerves, "but it didn't resolve the problem," Matthew said.

Meanwhile, abdominal issues made more surgeries necessary. All the incisions and internal repairs affected his core strength. Nonetheless, he finished the semester and eventually earned his master's.

He moved on to get his doctorate. In 2007, while prepping mule deer biological samples for a Kaibab study, the pain was so excruciating that he curled up on the lab floor.

"I was flopping around like a fish out of water from the pain caused by the damaged nerves in my spine. My right leg would go out as well. I crawled to my pickup and drove home," Matthew said. "The pain put a screeching halt to everything."

The challenge of pain management

What is a physical medicine and rehabilitation physician?

Physical medicine and rehabilitation physicians focus on restoring functional ability and quality of life to those with physical impairments or disabilities affecting the brain, spinal cord, nerves, bones, ligaments, muscles, and tendons.

Three more back surgeries — including two fusions — followed to help stabilize his spine.

"After the second fusion, I have been trying to hold on to the good disk above the fusions like it was gold," Matthew said.

In 2008, despite all his health challenges, he finished his doctoral field work on the Kaibab. Lab work and literature research followed, and in 2014, he earned his doctorate in environmental planning and design (wildlife habitat management). A full-time job is elusive, however.

"I have to lie down periodically and rest," he said, and employers aren't very accepting of that. He now works from home as a writer in wildlife habitat management and nutrition.

From 2008 to 2016, Matthew cycled through physical therapy treatments and pain management doctor visits, with his opioid usage going up and down.

"What I learned was that the bone pain could resolve, but that decompressing the spinal nerves didn't take away the nerve pain in my legs and spine. The scar tissue and damage to the spinal nerves is permanent," he said.

Managing his pain continued to be a big challenge.

"My pain management doctor treated me like a criminal," Matthew said with disgust. "He thought I was after opioids. I wasn't. I was after relief from my pain. I wanted to be able to think, to get my mind back. My pain level and opioids were preventing that."

Finding some relief

With Matthew's referral to Dr. Hennenhoefer at HonorHealth in 2016, he found some relief. She helped him in several crucial ways:

  • Steroid injections in his back. "She's really good with a needle," Matthew said. "She's able to find the right spot, even around bony growths in my spine. With her management of the steroid dosage, I haven't experienced the 'roid rage' I've had in the past. Just being around her motivated me to go off the fentanyl patch cold turkey. I didn't even tell her I was doing it until afterward. It wasn't my best decision ever," he said with a laugh.

    Dr. Hennenhoefer noted that Matthew "will likely continue to require epidural injections to help keep his pain controlled. He has needed the injections less frequently since we maximized his medication management."

  • Physical therapy and daily exercise that includes walking and training his 1-year-old German shepherd, Ilsa.
  • Pregabalin to control nerve (leg) pain. "Dr. Hennenhoefer adjusted the amount to a more even dosage so that I don't feel like a stone," Matthew said. "Recently we decided to use the extended-release version, which greatly evened out the peaks and valleys of my nerve pain."
  • Fewer opioids. "What I found over the years is that no medication lasts the period of time it says it will. If it says 24 hours, it's actually 18. I'm at a level now where I can manage the pain."
  • NSAIDs (ibuprofen, aspirin and prescription-strength medications), which help control osteoarthritis and bone pain. Matthew noted that CBD has also helped.
  • Venlafaxine, an antidepressant "A few months ago, a physician mistakenly injected a healthy disk and set off more nerve pain in my legs and inside my spine," Matthew said. "Deep down inside was a chronic, gnawing nerve pain that went inside my core and wanted to stay there. It was a festering pain that no opioid or NSAID had ever touched in 15 years. I started asking myself, 'Do I want 30 more years of this?' The answer was no. But I never talked about it."

Until he met Dr. Hennenhoefer, that is. "She's open to honesty. I didn't want to lie to her because of who she is," he said. "She asks questions that you might not be ready to admit to yourself. She's incredibly compassionate. She's top-notch."

In November 2018, she prescribed venlafaxine, an antidepressant that Matthew calls a godsend. "Antidepressants typically take six to eight weeks to work for depression. I took one tablet, and it worked to block the festering spinal pain that night! Angels from heaven sang," he said with a laugh. "Over time, she refined the dosage and when to take it. As long I'm doing what I should be with my activity level every day, the nerve pain that was driving me nuts disappears."

"Chronic pain," Dr. Hennenhoefer noted, "causes people to be depressed since they can't do the activities they would like to do. Also, being in pain every day tends to make you not very happy. This in turn causes the pain to increase. It's a vicious cycle. So you have to treat both the depression and the pain in order to help them. When we started Matthew on the venlafaxine is when we saw the most improvement in his pain symptoms. I was able to help control his pain, which in turn improved his daily functioning."

More good days now

When he has good days consistently now, he can write and edit, work on photos, collect field and lab data and even go hunting when the opportunity arises.

"If there's a silver lining to all this," Matthew said, "it's that you don't realize how big a hole you're in until somebody shines a light and helps you out."

Learn more

For help with neck, back and other joint and muscle pain, consult with a physical medicine and rehabilitation physician.

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