Somatic Experiencing & Chronic Pain: Trauma and the Body | Episode 18

Sandy was recently asked to speak on a workman's compensation panel about somatic experiencing — and she is bringing that same depth of expertise directly to this episode. If you have ever wondered what somatic experiencing actually is, how it differs from talk therapy, or why chronic pain so often has a nervous system story underneath it, this is the most comprehensive answer Sandy has given on the podcast.

What This Episode Holds

• What somatic experiencing actually is, how Peter Levine developed it, and why it works at the physiological level rather than the cognitive one
• The concept of pendulation — and Sandy's simple, memorable way of explaining it to clients
• Why trauma is stored as unresolved survival energy, not as a memory — and what that means for healing
• The animal world's natural discharge response (and why humans rarely get the chance to do what every other mammal does instinctively)
• How acute pain transitions into chronic pain, and why that shift is often about protection rather than ongoing tissue damage
• What healers and clinicians should actually be watching for when recognizing nervous system dysregulation in themselves or their clients
• Why chronic pain is reversible when the nervous system is addressed — and what that process actually looks like
• A powerful personal story from Sandy's clinical research days about connection, placebo effect, and what genuinely helped patients' pain scores improve
• An illuminating conversation with rheumatologist Dr. James Fant about fibromyalgia, trauma correlation, and why so many physicians who pursue this connection face professional pushback
• Why shifting from suspicion to safety may be the single most important change in how we approach chronic pain treatment

Who This Episode Is For

• The therapist or healer curious about body-based modalities and how they differ from traditional talk therapy
• Anyone living with chronic pain who has felt dismissed, doubted, or told it's "all in their head"
• The clinician working with workman's compensation, chronic pain, or fibromyalgia populations
• Healthcare providers wanting to understand the nervous system science behind why connection and validation measurably improve patient outcomes
• Anyone curious about the deep, often under-discussed relationship between unresolved trauma and physical pain

"Chronic pain often reflects a nervous system that's never received the signal that it's safe again. And that experience has to be felt. It cannot be told."

The nervous system is plastic. The brain can relearn safety. And when threat perception decreases and regulation improves, people experience real, measurable reductions in pain — not because the pain was ever imaginary, but because the body has finally been given what it needed to complete the process it was always designed to complete.

We were never built for the breakneck pace of the world we live in now. But we are built to heal. Sometimes all it takes is curiosity, safety, and someone willing to notice.

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Transcript

SPEAKER_00 0:10

Hey guys, welcome to the Brain Dump with Sandy Boone. I am your host, Sandy Boone, and I am here today to talk about somatic experiencing. I have been asked to speak on a Workman's Compensation panel about the effects of somatic experiencing. And so I thought I would use that information to do the podcast today because it's a modality that I get a lot of questions about. So who better to share with than you guys? I am just going to go through today and kind of give you guys the questions that have been prepped for me because I think they're great questions. And I think that this will give lots of you information that you've been searching for. So one of the questions I get asked the most, particularly for those outside of the therapeutic world, but sometimes even those of us that are inside the therapeutic world, what is somatic experiencing and how does it differ from traditional talk therapy? Somatic experiencing was developed by Peter Levine, and it's a body-based approach that we can use to resolve trauma and chronic stress. And instead of focusing primarily on the story of what happened, SC focuses on what is happening in the nervous system right now. And the beauty of this work is that we can really assist our clients with not being in that space of emotional flooding. And in my opinion, I agree with the statement that trauma happens when we experience we experience something too much too soon or too little, not enough. And so trauma occurs when our nervous system is overloaded. And so somatic experiencing uses a concept called pendulation, which the pendulation I share with my clients, it's like burping the Tupperware lid, right? It's like, can we go a little bit into that trauma or into that negative experience? And then can we back it down into something that brings us comfort so that whatever happened, we're giving it time to move through the nervous system. Traditional talk therapy works on a cognitive level. So if we're looking for problem solving or we're looking for challenging negative cognitions, which again, there's a time and a space for that. If we want to change thoughts and beliefs, traditional talk therapy works well for that. SE works physiologically, it's helping the body complete that stress response. And we're assuming that the stress response somehow got stuck. And again, trauma is not just an event, it's a dysregulated nervous system. So when regulation is restored, symptoms, including pain, often decrease. And people often come to me for somatic experiencing for specifically for pain, because either they don't want pain medications or they've been on pain medications and they're losing efficacy. Um, there's addiction concerns, all of those things, which you guys are well familiar with. I also get asked, how does trauma live in the body and what does that have to do with chronic pain? Trauma is not stored as a memory vial, it's stored as unresolved survival energy. And one of the things that I will share with my clients is that if you think about when a when a dog is chasing a cat, right? The they're running and maybe they're even playing, but you know, they're running around, the the dog is chasing the cat, the cat is clearly distressed on some level, and then the cat will climb up a tree or jump up out of the dog's reach, and you will immediately see that cat shake and then it starts to lick. And so that shaking is the discharge of that survival energy. When was the last time you saw somebody shake? We we don't do that anymore. And so when someone experiences an injury or certain sudden shock, that nervous system will mobilize for survival. And if that activation does not fully resolve, you know, if we don't get that shake or we don't get that opportunity for that nervous system experience to come back to normal, the body can remain in a defensive posture, it can remain hypervigilant, we can have muscle guarding, we can have shallow breathing, we can have elevated stress hormones. And so over time, that sustained defensive state increases inflammation, it increases tension, and it can increase pain sensitivity. So it has been my experience that chronic pain often reflects a nervous system that's never received the signal that it's safe again. And if you think about safety from a trauma perspective, that experience has to be felt. It cannot be told. So when that, you know, again, never in the history of the world has it worked to tell someone to calm down and they calm down, right? Like that just doesn't happen. So, you know, we we run into this with ignoring our nervous systems, which is we've we've become really good at doing that. Another question that's coming is going to be on this panel is what's happening in the nervous system when someone develops persistent pain after an injury? And if we think about everything that the body does, it does for protection, it does for healing, it does for the sake of staying alive. And so initially that pain is protective and it alerts us to tissue damage. So if we touch a hot stove, we feel the heat because it's burning us and we need to move our hand. But when pain persists beyond the tissue healing, the nervous system may have become sensitized to it. The brain and the spinal cord will amplify signals and the alarm system becomes overactive. And so the nervous system is no longer responding to just tissue damage damage, it's responding to perceived threat, which could be the fear of re-injury, or it could be financial stress, or it could be job insecurity, or it can be feeling disbelieved, particularly in our medical system, right? We we like we like our patients or our clients to, you know, let me do this x-ray, let me do this CT, let me do this MRI or ultrasound or lab work, and let me see what's actually going on. And when we don't find those things, then we start saying it's all in their head. And then when we believe that it's all in their head, we get into the space of we don't treat them. And so then we create more trauma, right? Like it, it it's just this vicious cycle. So injury can transition from acute pain to chronic pain even after tissue healing. The acute pain, remember, is about injury. The chronic pain is often about protection. If the injury was a was frightening or it was tied to an identity loss, or the nervous system can remain in survival mode and the muscles stay braced, breathing stays shallow, and the system does not downshift. The cortisol levels just stay high. Ongoing stress, such as, you know, the disbelief in the medical arena or navigating work in workmen's comp systems, or gosh, even, you know, the loss and the grief of not being able to do the things that you could once do, it prevents the recalibration of the system. And so when the safety increases, pain frequently decreases. But again, it's it's got to be a felt sense of safety and not just you're safe, you're okay. I also get asked, like, how can we as healers recognize signs of nervous system dysregulation? And I get asked this a lot with my clients who are therapists that aren't really in the body-based arena yet. What we're looking for is patterns and not necessarily pathology. So sometimes, you know, you may see that, or your client may report excessive startle responses, um, irritability or shutdown, inconsistent pain report. You know, I had a lot of pain yesterday, but today's not so bad. They have difficulty tracking information. So maybe there's memory gaps, maybe there's, you know, a lot of did that happen before this or did this happen before that? There can be a lot of emotional reactivity. There can be a flat affect or collapse. And I think we often miss this as healers, that collapse response or that people-pleasing or over-accommodating response. And when you start to notice nervous systems, you notice nervous systems. You can't unsee it. And I think it's our job as healers to recognize that these aren't, you know, difficult behaviors. They're not someone trying to be difficult. They're survival states. You know, a regulated nervous system is flexible. It can take on a challenge and it can come back into regulation. A dysregulated nervous system is rigid. You know, it can be overly activated or shut down, and there doesn't seem to be a lot of in-between. And I often get asked or people seek help from me, wanting to know if chronic pain is reversible when the nervous system is addressed. And yes, absolutely. Not because the pain was imaginary, it was a very real-lived experience. But the nervous system is plastic. The brain can relearn safety. And when we reduce that threat perception and we improve regulation and we help the body release that defensive tension, many people experience significant reduction in pain intensity and frequency. Even when the pain does not disappear completely, function and quality of life almost always improve. In working with people with chronic pain, uh, sometimes I have been in this space of helping them recognize how being around a toxic family member contributes to the pain or how pushing too far contributes to pain. And so, you know, the bottom line is we get into a really big mess when we fail to ignore our bodies. And the culture that we live in encourages us to ignore our bodies. We were never designed for this breakneck system that we're in. And so, if I could shift one thing about how we approach chronic pain, uh, it would probably be to shift from suspicion to safety. You know, when people feel believed and validated and respected and supported, their nervous systems settle. When they feel scrutinized or doubted, their systems brace. And so healing requires that physiological safety, not just medical intervention. And so systems that communicate belief and support improve outcomes. I I learned this in my clinical research days. Um, the drug companies indicated that um I had a really high placebo rate when I worked with my patients. And I don't doubt that. You know, when you're talking about working with osteoarthritis, which is that the arthritis our grandmothers have, and some of us in middle age are starting to get now, you know, it's that wear and tear arthritis. And I worked with, I called them my grandmothers, the older ladies that, you know, their their families were busy, the grandkids had gotten older, they weren't really really ready to help out within the family like they did in the past. And, you know, I often heard, my family is too busy for me. And, you know, it was heartbreaking, but having these women come in to see me on a regular basis. And again, that regular basis was dictated by the protocol, right? Sometimes it was every few days, sometimes it was every few weeks. But having these women come in and having conversations with them, you know, like something had happened. And, you know, there is this theory that history repeats itself. So certainly during the 1990s, things weren't quite as uh dumpster fiery as they are right now, but you know, things happened, right? There were things happening on the news. And so having these people say, Did you see this happen today? And I said, Yes, I did see that. Have you ever seen anything like that? Tell me about that. Or, you know, this weekend I went to the beach for the day. And did you ever go to the beach when you were younger? And, you know, it's that storytelling, it's that connection. And, you know, these these people, you know, part of my job was was encouraging them to finish the study so that we could get good clean data and we could get good, clean research. And um, of course, there were financial gains to that too. We would get paid more when when patients finished the study. But, you know, I would send birthday cards, I would send holiday cards, I would purchase little Hershey's Kisses for Valentine's Day and, you know, give a little cup of Hershey's Kisses. You know, these things mattered so much. And so I remember one of the things that happened in the research studies, they would do something that was called a VASC score, which you may or may not be familiar with or remember from your grad school days, but you know, it's a line. And you're supposed to put, take a pencil or a pen and put a line of where your pain is on a scale of like zero to ten or zero to one hundred or whatever the scale is. And part of part of the studies was often to they wanted the pain to to increase because they had stopped a treatment medication, or you know, they wanted it to improve if they had given some sort of rescue medication. And so, you know, if I saw a patient one week and then I saw a patient the next week, I often had patients that weren't eligible to move forward in that study because their pain scores increased and nothing had happened except that connection. So, you know, I don't think that we can say, you know, connection heals every single thing, but connection heals a lot of things. And, you know, these women would go with a pain score of 70 or 80 or maybe even 90. And because they knew they were going to see me in a week, that pain score would drop down to 40 or 30. And so we had to do a lot of education, again, ethically, not guiding, not telling them what to write. But if they said things like, My pain is better, how is it better? Are you as active as you were? Um, did you, did you become more active over this last week? And, you know, it also went the other way. I remember specifically with my own grandmother, she enjoyed doing clinical trials. And she, one of the nurses would say, on a scale of one to ten, ten being so bad that, you know, you need to go to the hospital because this pain is just so bad. And my grandmother's answer was always a seven. It's a seven. She was not going to go to the hospital, right? Like that was not, she just wasn't. So she wasn't gonna give the indication that her pain was anything more than seven. We're not getting close to that level of hospitalization. And I remember taking her to one of her appointments, and the nurse had asked, you know, on a on a schedule scale of one to ten, how's your pain? My grandmother says seven. And I said, Grandma, you didn't get out of bed like three days last week. That's not a seven. And she's like, but I didn't need to go to the hospital. And again, that resistance to go to the hospital for whatever reason, you know, she didn't she didn't want to go there. So languaging matters, the relationship matters, and we we just have to be aware of the connection and how connection makes a difference in the lives, difference in the lives of those that we want to to serve or we want to help. So another fun fact, because I am story driven, you guys know that. I had an opportunity to talk with Dr. James Fant, and I had worked with him. He was the first, one of the first physicians that I worked with in clinical research. He's a rheumatologist here in uh Columbia, South Carolina. And his work, he has a heart of gold. That man is is a good man. And he it was so important to him that when patients came to see him, that they left feeling better. And he told me one time that the way he did that, the way he ensured that they felt better was to make sure that they were heard. And so when his patients left, if they had not been doing well, he was going to change something. You know, he was gonna up medications, or he was gonna provide another method for pain treatment, or he was gonna recommend a referral to another specialist, or, you know, he he knew that people got better when they felt heard and validated. And so he ended up with a caseload that lots of chronic pain. And this was this was kind of in the advent of fibromyalgia when it was becoming a catch-all diagnosis. And so several years ago, I had an opportunity to connect with him again. He graciously agreed to do that. And I wanted to talk with him specifically about chronic pain and fibromyalgia. And this was in response to I had read several books by Dr. Gabor Mate. And I wanted to know: were my clients that had experienced trauma, you know, was there this high correlation? Was it really as high as I thought it was? You know, that if people had chronic pain, there was always trauma. Because that had been my experience as a counselor, right? And I had been out of the rheumatology arena long enough that, you know, I'd forgotten some things. And we went into this great, interesting conversation. We talked for two hours, but we went into this conversation about how he felt that fibromyalgia was a nervous system on fire and that he didn't generally screen from trauma right away. And his thought process was, I'm not necessarily gonna do anything about that. And he said, but when he worked with people for years and he helped manage chronic pain for years, it often came up that there had been some childhood trauma or there had been some major trauma later in life. And the pain started shortly not shortly after that. And so he shared some research with me about a practitioner that started using methadone to treat fibromyalgia pain. And he, and he shared that this practitioner was saying that he had a hundred percent success rate with methadone for the treatment of chronic pain. And, you know, anytime I hear 100% or never, the therapist in me goes, um, but and and you know, Dr. Fance said, I didn't have I haven't had 100% success, but I've had a lot of success with it. And he said, you know, methadone changes the way the brain perceives things, it changes the way the brain responds. And so, you know, we know methadone from a substance perspective, right? It changes the way the brain desires substances that someone's trying to stop using. And so the fact that methadone could be used to change the perception in the brain. And, you know, the medical field, again, I think they know this. They're starting to realize this. But the systems that they have and the way they've been taught, you know, if a doctor goes down this path, such as Dr. Gabor Mate or Dr. Jim Vant, there they get a label, right? Um, I mean, he shared with me that colleagues in administration had told him your education could be better used, treating real disease, not things you can't find. And, you know, his passion was not like that, that's not who he was. He wasn't just gonna turn these people out to the cold and not do anything because he realized chronic pain makes, you know, patients will have depression, they'll have anxiety, they have a loss of quality of life. And, you know, that's why we go into these healing professions because we want people to have the best life that they can have. And so just, you know, having that conversation and that dialogue. And, you know, at the end of the day, I I sent Dr. Gabor Mate's book to him as a thank you because he wouldn't let me pay him for his time. And, you know, doctors, their time is valuable. And well, everybody's time is valuable, but you know, I wanted him to know how much I appreciated him taking time out of his day. And he thanked me. And knowing him, he read that book. I know he read that book. And, you know, it we can do so much more if if we have conversations and talk and work together. And I shared with him my experiences of working with people with trauma, and he shared with me his experiences of working with people with chronic pain. And we both won. We both took away information to help people that we work with. And so that's what it's about, right? So with pain, you know, again, if we can get out of the talk therapy mindset and don't be afraid to talk about the pain because you need that information to track the nervous system. But also, I would encourage you to ask yourself, what are you what are you doing to help shift or to help change that? And there, there are always physical reactions to somatic experiencing work, whether it's temperature changes or heaviness or pain or whatever, there's going to be a physical reaction to somatic work. And often when clients will say to me, I could take care of myself, I will stop them and I will say, Can you say that again? And they'll say, I can take care of myself. And my question then becomes, Can you feel that? Where do you feel that in your body? And I'll get a yawn, or I'll I'll get shoulders settling or a relaxation. And you know, these are tiny, tiny micro interventions that have tremendous effects. And I would encourage you to approach that with curiosity and lean into the brain's ability or the brain's desire to heal, the body's desire to heal. We're designed to heal. And we just have to give uh give the system time to do what it's engineered to do. So all of that to say there that there's a big frontier here that is fascinating. It's fascinating to clinicians such as us, like counselors, is fascinating to physicians, and there's a benefit to us to learn more. And how do we learn? We learn by observation, we learn with curiosity. So be curious. Observe your clients' nervous systems, notice those little micro movements that are their norm, and maybe point it out to them. You know, I noticed when you said that you looked away. What was that like for you? Was that relaxation or was that to help you get your thoughts together so you could share more? Like, just be curious. With that being said, thanks for joining me today. And I look forward to seeing you and talking with you next time. Have an amazing day.