Reply To: Live Workshop 1

Home Forums Restricted content Live Workshop 1 Reply To: Live Workshop 1


Case study: (I got permission from this client to submit her information and have changed identifiers).
59-year-old married female professional was referred to me at the behavioral health clinic by a LMFT therapist who has been seeing her for several years for Anxiety, depression, panic disorder, and ADHD with chronic low back pain. She has been told that she can rewire her brain and is interested in learning more about this and finding more ways to treat the pain without medications. She has undergone multiple back surgeries, injections of her shoulder’s and is in ongoing physical therapy. Her most severe area of pain over the last few years is her low back. She reports that she knows that she has overused her back and has done a lot of high intensity extreme athletic events such as cycling. The reason that she exercises so much is to treat her anxiety, depression and pain. She had some injuries as a gymnast and was told to push through the pain- that is an old pattern for her. Her pain correlates well with stress in her life and she is aware of this link. Most recently she had a spinal fusion done in a large metropolitan area in July 2022. She reports discomfort with prolonged sitting or prolonged cycling with some radicular symptoms down the posterior right buttocks into the posterior thigh. Given the amount of injuries that she has had, I asked her to contact the surgeon from July and clarify what the parameters are for her in terms of safe amount of exercise.

Past Medical Hx also includes Hashimoto’s thyroid disease, A/V nodal reentrant tachycardia status post ablation, dyslexia, history of multiple vertebral and facet fractures from injuries, GERD and glaucoma.
Spinal fusion of L4 -S1

OVIDDX handouts completed with client- body map reveals: Multiple areas of pain including left elbow bilateral knees bilateral ankles right hip low-back, both shoulders and neck. Lifetime stressors include: in utero severe stress of her mother, Emotional neglect, mental illness in her household; adult stressors include multiple accidents, two previous divorces, change in sexual functioning, multiple deaths in her family from COVID 19, work stress, financial stress, ongoing stress as a parent of a trans-young adult and a lesbian young adult (the father of these children has rigid religious beliefs which have been very stressful on these young adult children).
Lifetime Review of Symptoms: Is positive for TMJ, neck pain, back pain, piriformis syndrome, shoulder pain, knee pain conquered, frequent urination, menopause dysfunction, numbness, anxiety
Personality traits include perfectionism, high expectations, conscientious self, overly responsible, rule following, low self-esteem, putting others needs first, hypervigilance, and worrying although this is improving

Medications include: Escitalopram Oxalate 20 mg po qd
Vyvanse (Oral) 20 mg po qd
Montelukast Sodium 10 mg po qd
Levothyroxine Sodium 25 mcg po qd
Estradiol (Oral) 0.5 mg po qd
Cyclobenzaprine HCl 5 mg 1-2 po QHS Prn
Progesterone Micronized 100 mg po QHS
traZODone HCl 50 mg po QHS
Diclofenac 75 mg po BID prn

PE: thorough musculoskeletal and neurologic exam which was essentially normal except for Mildly tender posterior cervical muscles and mild-moderate anxiety.

Labs/data: 6/2022 basic labs are normal including TSH. 8/2022 lumbar xrays: Frontal lateral views lumbar spine are obtained. s/p posterior fusion and decompression from L3 to L4. Disc spacers from L3-L4, L4-5, and L5-S1. mild shift scoliosis noted centered to the right at L1 to the left at L4. Vertebral body heights are preserved. There is mild DDD at L2-L3..
2018 CT lumbar spine: Age-indeterminate right L3 transverse process fracture, likely subacute/chronic. L4-S1 posterior fusion without evidence of hardware complication. Minimal early partial osseous bridging across the intervertebral discs. MRI lumbar spine 2016 1. Moderate multilevel degenerative disc disease with mild central stenosis at L4-5 and borderline to mild central stenosis at L3-4 and moderate central disc protrusion at L5-S1. 2. Marrow edema in the left pedicle/pars at L5 likely DJD or stress related.

Questions: Clearly a lot of her symptoms seem to be related to a mind-body syndrome but she also has injuries/hardware in her back. Like to discuss working with her to turn off the danger signal. So far I’ve been working with her on psychoeducation, psychotherapy to help calm down the hypervigilance, increase mindful awareness, reduce her night time alcohol use, teaching more autonomic regulatory practices to help her calm the nervous system down (primarily in flight). She is responding well and appears much less anxious. Next steps will be to do more somatic tracking exercises..
thank you