A case study on working with chronic pain using Feldenkrais Method and Somatic Experiencing
A first session:
Andréa came to me complaining of chronic back pain that was sometimes severe enough that she couldn’t walk without a cane. She was diagnosed with degeneration of the nerves in all of the vertebrae of her lumbar spine. Andréa had fulfilling work that kept her very busy but was sometimes hindered by the pain, and described a full personal life with a partner, friends and family connections. I found her quick to laugh and crack a joke but underneath that, she was struggling with a lot of pain and anxiety.
Andréa’s back pain wasn’t just painful, it came on in times of stress, and she spiraled down as the pain caused further anxiety. Her pain wasn’t just pain — it was coupled with a state of fight/flight/freeze, which made it all the more daunting. When she was in pain, she felt panicked and got “lost in a swirl” as well. When she wasn’t in pain, she was often worried about when it would come back.
Andréa and I first began our work together by trying different ways for her nervous system to register a baseline of safety. This was achieved first simply by talking about what brought her to me in detail without hurrying her, so she had time to make sure she was reasonably comfortable with me. Next I invited her to try a practice that was intended to be settling. However, for Andréa, the pain of her lower back overpowered any chance of settling. Rather than feeling relaxing in a way that would signal safety to her nervous system, the relaxation practice I taught her seemed silly and way too small to possibly influence the pain she was feeling.
Since the back pain couldn’t be ignored and was coloring everything else we’d tried so far, I pivoted to focusing on what was calling out for her attention. We explored her back pain directly. I had Andréa try to map exactly where the pain was most clearly felt, and where the borders of the pain were. She gestured with her hands to show me the areas of her back where the pain was most prominent, and then to show me where it ended. As you might expect, her experience of the pain increased slightly with so much attention paid to it, and so we spent some time noticing that too.
Next, I asked her to try something which she’d never tried before. Since she could name and point to where the border of the pain was, could she cross that border and notice exactly where in the body the pain wasn’t? Andréa was intrigued, and immediately got curious about noticing the areas of her back that felt neutral, with no pain, and could even locate areas that were right up to the edge of where the pain began. With that shift in attention, she noticed her pain reduce significantly. When we’re in severe pain, it’s understandable to lose track of the areas that feel neutral or better even when that when the pain is a small area, and a great majority of our body feels neutral. The pain is the body’s alarm signal telling us that something is wrong and so it demands our attention. But often with chronic pain, the alarm going off no longer corresponds to a physical issue that we need to attend to. That was the case for Andréa and she got very excited about this different way of tuning into her body sensations, and this new-found skill to affect her pain.
Curiosity is a signal of being safer for the nervous system. Our curiosity for what might come next gets severely limited by a sense of threat. And so, with this simple experience, we had introduced curiosity and more safety where there had been mostly dread and panic. We also tend to register being safer with an increased sense of agency. Andréa’s system registered (I believe) that greater sense of safety as she realized she wasn’t fully out of control when it came to her reaction to the pain and anxiety.
I wasn’t sure if this effect would continue to work for Andréa or would fade as some novel approaches do. In Andréa’s case it did continue to help and noticing “where the pain wasn’t,” was an idea that we returned to often in future sessions. It was a powerful first step in breaking up a long-held pattern — the back pain signals were no longer the only story being told in her body. Now there was a second story being told — by all the areas of her back that felt neutral or better, and the satisfying experience of using a shift of attention to ease her own pain.
Further Healing
Andréa and I went on to work together once a week for a little over a year. We worked a lot with her awareness of habitual patterns of muscle contraction and how they influenced her movement. This led to new patterns of coordination and posture that felt easier and put less strain on her back. As her back pain eased, she became curious about how our work extended beyond coordination and managing pain.
We began to explore how when thinking of difficult experiences from her past, she could track her body’s protective patterns until they completed and she regained a sense of ease. We also went into directions even further afield from her original goal of healing back pain — she found that a fear of not being understood could be clearly tracked in her body, which resulted in shifting toward an ability to speak more directly and effectively with colleagues at work.
Over the first few months of working together, Andréa found that the back pain no longer held the same power of fear for her. She was able to put away her cane since her back pain episodes, when they did recur, were far shorter and much less intense. With a significant reduction in pain, she was able to enjoy travel and other elements of her life to a greater extent. She ended sessions, letting me know she felt more in touch both with her body, her feelings, and with her sense of agency and strength in herself.
(Client’s name and some identifying details have been altered for confidentiality)
