































Feldenkrais Research Journal • volume 1 (2004)

Article

The Feldenkrais Method In The Treatment Of Chronic Pain:
A Study Of Efficacy And Cost Effectiveness

David Bearman
MD; Santa Barbara Regional Health Authority, Goleta, California

Steven Shafarman
Founder and CEO, FlexAware

Abstract
A preliminary study was undertaken to determine both the efficacy and cost effectiveness of the
Feldenkrais Method for treatment of Medicaid recipients with chronic pain at the Santa Barbara Regional
Health Authority (SBRHA). SBRHA staff wished to offer treatment for chronic pain patients beyond what is
provided for in the Medicaid scope of benefits. Conventional intensive chronic pain treatment programs
costs range from $7,000 to $30,000 and are not covered by regular Medicaid benefits. Patients with
chronic headaches and/or musculoskeletal problems were enrolled in the study. Seven patients began the
program; all completed it. Patient satisfaction, function and perception of pain were evaluated by using
the National Pain Data Bank (NPDB) protocol of the American Academy of Pain Management.
Participants reported more mobility and decreased perception of pain, both immediately after the program
and in a one-year follow-up questionnaire. Results compared quite favorably with NPDB comparison
groups. Cost effectiveness calculations were based on Medicaid costs for one-year periods pre- and
post-intervention. Patient costs dropped from an average of $141 per month to $82 per month. This
represents a 40% savings.

Keywords
Alternative medicine, chronic pain, complementary medicine, cost effectiveness, Feldenkrais

Copyright ©: The copyright for this paper remains with the author(s).

First published: American Journal of Pain Management, Vol. 9 No. 1 January 1999, p. 22-27.

Please cite: Feldenkrais Research Journal, volume 1; 2004.

Service marks: The terms Feldenkrais®, Feldenkrais Method®, Awareness Through Movement®, ATM®,
Functional Integration®, and FI® are service marked terms of the International Feldenkrais® Federation
(IFF) and Feldenkrais professional guilds and associations in many countries. In keeping with academic
conventions, they will not be service marked in the entire text as may be required in nonacademic use,
but only for the first and most prominent use of the terms. In recognition that these phrases are formal
terms referring to specific practices within the Method, and to the Method as a whole, capitalization of all
the words in each term has been retained.

Published by the International Feldenkrais® Federation (IFF) https://feldenkrais-method.org
Available online at https://feldenkraisresearchjournal.org

https://feldenkrais-method.org/
https://feldenkraisresearchjournal.org


     
IFF Academy 

Feldenkrais Research Journal 1 (2004) 
® 2004 by the author 

THE FELDENKRAIS METHOD IN THE TREATMENT OF CHRONIC 
PAIN: A STUDY OF EFFICACY AND COST EFFECTIVENESS 

American Journal of Pain Management 
AJPM Vol. no. 1 January 1999 

 
By David Bearman, MD, and Steven Shafarman  
 
Abstract. A preliminary study was undertaken to determine both the efficacy and cost 
effectiveness of the Feldenkrais Method for treatment of Medicaid recipients with chronic 
pain at the Santa Barbara Regional Health Authority (SBRHA). SBRHA staff wished to offer 
treatment for chronic pain patients beyond what is provided for in the Medicaid scope of 
benefits. Conventional intensive chronic pain treatment programs costs range from $ 7,000 to 
$ 30,000 and are not covered by regular Medicaid benefits. Patients with chronic headaches 
and/or musculoskeletal problems were enrolled in the study. Seven patients began the 
program; all completed it. Patient satisfaction, function and perception of pain were evaluated 
by using the National Pain Data Bank (NPDB) protocol of the American Academy of Pain 
Management. Participants reported more mobility and decreased perception of pain, both 
immediately after the program and in a one-year follow-up questionnaire. Results compared 
quite favourably with NPDB comparison groups. Cost effectiveness calculations were based 
on Medicaid costs for one-year periods pre- and post-intervention. Patient costs dropped from 
an average of $ 141 per month to$82 per month. This represents a 40 % savings. 
 
Descriptors. Alternative medicine, chronic pain, complementary medicine, cost effectiveness, 
Feldenkrais 
AJPM 1999; 9:22-27. Received: 10-16-98: Accepted: 12-10-98 
 

INTRODUCTION 
 
The Santa Barbara Regional Health Authority 
(SBRHA) serves 41,000 Medi-Cal (California 
Medicaid) patients in Santa Barbara County. It 
has operated since 1983.SBRHA, created by a 
special act of the California State Legislature, 
has much more flexibility in its scope of 
benefits that the state-administered Medi-Cal 
program. The SBRHA board of directors has 
used that flexibility to approve experimental 
trials of various new modalities. 
Dr. David Bearman is Deputy Director of Health Policy 
and Grant Development for the Santa Barbara Regional 
Health Authority, SBRHA. For the previous 14 years he 
was Medical Director and Director of Medical Services. 
Mr. Shafarman is a certified Feldenkrais practitioner in 
private practice in Santa Barbara. He studied with Dr. 
Moshé Feldenkrais from 1976 –1984 and is the author 
of Awareness Heals: The Feldenkrais Method for 
Dynamic Health. Address reprint requests to: Dr. David 
Bearman, Santa Barbara Health Authority, 110 
Castilian Drive, Goleta, CA93117. 

Traditionally, patients with chronic pain have 
been demanding of their primary care 
providers and generally unhappy with their 
health care. Health care professionals have 
been frustrated with the inability to provide 
adequate relief and lack of resources for 
patients who were unresponsive to 
conventional pain treatment methods. To 
address these concerns, SBRHA decided, in 
1995, to use its flexibility to provide, on a 
trial basis, services beyond the Medi-Cal 
scope of benefits. 
Our focus is on patients who have limited or 
no response to conventional treatments for 
chronic physical pain from injuries, surgeries 
or chronic conditions. Many of these 
members also have coexisting mental health 
problems, such as depression and anxiety. 
Several have exhausted conventional medical 
options. For most of these patients, pain 
relief typically consists of prescription 
medications or self-medication with alcohol 
or illicit drugs. 

 



 
2 

D.Bearman & S.Shaffarman/Feldenkrais Research Journal 1 (2004) 

 
These patients are both difficult to manage and costly. Most exhibit a variety of difficulties 
that characterize pain-related immobility, including physical degeneration and other 
pathologic conditions. Like most chronic pain patients, members in our target population have 
been prone to depression, hopelessness, the loss of supportive relationships, and the 
breakdown of meaningful social contacts. In light of the patient population, SBRHA sought a 
treatment intervention that would both help the patient and assist the primary care provider 
with patient management. The treatment needed to be justified on grounds of both therapeutic 
efficacy and cost effectiveness. 
This article entails a discussion of a chronic pain program that used the Feldenkrais Method 
exclusively. The program was evaluated by using data processed by the National Pain Data 
Bank (NPDB) of the American Academy of Pain Management. Cost effectiveness was 
assessed by comparing Medicaid costs for one-year periods pre-and post-intervention. 
 

RATIONALE 
 

The basic rationale for investigating complementary/alternative medicine was one of 
economics and patient and conventional practitioner acceptance. Simply stated, traditional 
pain management programs are costly. Annual health care costs for chronic pain Medicaid 
patients in our area are $ 1,000 to $ 7,000. Second, a 1990 study demonstrated that, in 1990 
alone, one-third of Americans visited alternative health practitioners, often without telling 
their primary care physicians (1), and more recent literature shows that number to be even 
higher (2). As has been noted, “numerous practices that are termed alternative, 
unconventional, or integrative medicine have become increasingly popular and prevalent” (3). 
Alternative/complementary therapies are gaining credibility with providers. Berman et al., 
reported that over half of family physicians surveyed considered alternative medicine 
interventions (including diet and exercise, biofeedback, hypnotherapy, and massage therapy) 
legitimate medical practices (4). The NIH Office of Alternative Medicine (newly named the 
National Center for Complementary and Alternative Medicine) estimates that over 50 % of 
traditionally trained physicians in the US use or refer patients to non-traditional treatment 
practitioners/modalities (5). 
 
Economics. Pelletier et.al. interviewed 18 insurers and found that a majority offered some 
coverage for nutrition counselling, biofeedback, psychotherapy, acupuncture, preventive 
medicine, chiropractic, osteopathy, and physical therapy (6). The authors concluded that 
consumer demand for complementary and alternative medicine (CAM) is motivating more 
insurers and hospitals to assess the benefits of CAM and suggested that “outcome studies for 
both allopathic and CAM therapies are needed to help create a health system based on 
treatments that work, whether they are mainstream, complementary, or alternative” (6). 
 

THE FELDENKRAIS METHOD 
 
SBRHA learned of the Feldenkrais Method through an independent case manager for 
Workers’ Compensation who described the good results she had been seeing with her patients 
who had not responded to conventional treatments. She reported that the Feldenkrais Method 
had been paid for by Workers’ Compensation and other third-party payers. And she 
introduced SBRHA to a local Feldenkrais practitioner who studied with Dr. Feldenkrais. 
Dr. Moshé Feldenkrais earned his doctorate in science at the Sorbonne in electrical and 
mechanical engineering and mathematics. In the 1930s, he was principal assistant to Frédéric 
Joliot-Curie in the research that led to Joliot-Curie’s being awarded the 1935 Nobel Prize in 



 
3 

D.Bearman & S.Shaffarman/Feldenkrais Research Journal 1 (2004) 

chemistry. From 1950 until his death in 1984, Feldenkrais lived in Tel Aviv and devoted 
himself to research on biomechanics and neurophysiology – and to developing the Method. 
As a teenager, Feldenkrais had severely torn the ligaments and cartilage in his left knee. He 
reinjured his knee while in England. At that time, numerous surgeons told him that an 
operation was necessary and that there was only a 50 % chance that he would be able to walk 
without a cane. His wife was a paediatrician, which provided him with opportunities to 
observe many infants and how they move and learn. Instead of surgery, he began to study 
himself and how he was moving, using his scientific training, experience, and insights into 
how babies learn to crawl and walk. He learned to walk freely without the benefits of surgery.  
The Feldenkrais Method has two forms – group and individual. Group lessons, Awareness 
Through Movement, systematically refine the process through which toddlers learn to walk. 
The practitioner uses verbal directions to guide people through specific sequences of relatively 
simple, comfortable movements. Most lessons take 45-60 minutes and are done while lying or 
sitting. Unlike yoga, chi kung, or other practices or exercises, people move at their own pace, 
in accordance with their unique needs and conditions, neither imitating anyone nor trying to 
achieve any particular goal. The emphasis is on awareness, on learning to sense changes or 
differences. In this way, one learns to eliminate excess effort or other inefficient habits, while 
simultaneously discovering more comfortable and effective alternatives. 
Individual Feldenkrais lessons typically last 30-60 minutes. They are usually done with the 
student sitting or lying on a low, padded table. The practitioner gently and precisely moves the 
student, turning the head, for example, or pushing or lifting a leg or arm. Practitioners are 
carefully trained to be sure that movements are relatively comfortable; movements are often 
quite small, although sometimes they can be rather large and playful. Students remain fully 
clothed.  
A fundamental precept of the Feldenkrais Method is that awareness and attitude are more 
important than any specific act. With back pain, for example, regardless of how it may be 
described or diagnosed, one only experiences pain when somehow straining, stiffening, or 
moving inefficiently. People typically assume that pain causes movement difficulties, yet the 
converse is equally true. As patients become more aware and learn to move more skilfully, 
both pain and ineffective movements resolve, improve, or are relieved. 
Feldenkrais lessons, with their educational emphasis, are compatible with all appropriate 
medical treatments, conventional or alternative. Each lesson, group or individual, is designed 
to enhance activities of daily living. 
 

PILOT STUDY 
 
The SBRHA administrative and medical staff was concerned about the lack of research 
substantiating the benefits of the Feldenkrais Method. The SBRHA administrative staff 
participated in an Awareness Through Movement demonstration. This exposure to the 
Feldenkrais Method was a factor that helped convince SBRHA management to recommend 
the pilot program to the SBRHA Board of Directors. The Board then approved the pilot 
project. Feldenkrais was offered as a special SBRHA benefit for selected members. The 
SBRHA program was designed and taught by a certified Feldenkrais practitioner and a nurse. 
 
Patient selection. At that time that SBRHA was considering the Feldenkrais Method, it was 
also evaluating acupuncture for chronic pain patients. SBRHA decided to conduct programs in 
both modalities and to select patients based on categories of chronic pain that had previously 
been shown to respond well to acupuncture treatment: musculoskeletal pain of the neck, 
shoulder, arm, and/or back; tension and migraine headaches; and pain following injury. 
Anxiety was a co morbid condition for most patients. Patients excluded from the study 



 
4 

D.Bearman & S.Shaffarman/Feldenkrais Research Journal 1 (2004) 

population included those whose pain had significant structural causes and also patients with 
cancer, over age 70, or those whose total annual health care costs were less than $ 1,000. 
 

METHODOLOGY 
 
After identifying members who might benefit from this program, the SBRHA medical staff 
communicated with the members’ primary care physicians to see if they concurred with the 
intervention and would work with SBRHA members on this pilot. 
Seven participants were selected. All completed the program. The goals of the treatment were 
to reduce complaints of pain, improve mobility and skill functioning, reduce use of licit and 
illicit analgesics, and reduce demand for health care services during the one-year follow-up 
period. 
The program began with a 2-week intensive phase, 4 to 5 hours each day, 4 days each week. 
This design was based on the immersion characteristic of conventional pain management 
programs. A secondary phase involved 6 more weeks with one meeting each week, 4 hours for 
the first two meetings, 2 hours for two meetings, and then just one hour for each of the final 
meetings. The participants met at Santa Barbara Cottage Hospital during August and 
September of 1995. 
The program consisted of primarily of Awareness Through Movement lessons. Lessons were 
chosen and designed to emphasize ways to sit and walk comfortably and to breathe easily and 
efficiently. Some individualized Feldenkrais was done with most of the participants, but only 
for about 5 minutes at a time within the group setting. At each meeting, participants were 
encouraged to describe any benefits they were experiencing and to reflect on how they were 
integrating new ideas and movement possibilities into their everyday activities. Group 
discussions were intentionally oriented toward positive issues and away from reports of pains 
or problems. A recurrent theme in the discussions was that toddlers learn to walk, and while 
doing so they outgrow crawling. Participants were encouraged to consider how the Feldenkrais 
Method was providing them with ways to “outgrow” their pains or problems. 
 

EVALUATION 
 
Efficacy. Therapeutic efficacy and cost effectiveness were evaluated by considering patient 
mobility, patient perception of pain, and total health care costs and pharmacy costs. The 
American Academy of Pain Management’s National Pain Data Bank (NPDB) test instrument 
was administered before the program, immediately post-treatment, and (by telephone) at one-
year post-treatment. This evaluation involved participant self-assessment of functional status. 
The NPDB classifies and analyses the benchmarks and quality of pain treatment programs, 
and compares programs throughout the US. The NPDB compared the Feldenkrais program 
with 12 other programs with 365 chronic pain patients in the category of “Small 
Multidisciplinary, Outpatient.” These programs are evaluated with regard to quality of life, 
functional status, patient satisfaction, and rates of return-to-work. 
The NPDB collects data on patients’ social history, history of treatment, and their quality of 
life. From the information collected at discharge and one-year after discharge, the level of 
patient satisfaction and the improvement in their quality of life can be assessed. The one-year 
follow-up survey was administered over the telephone in September of1996. Six of the 
original 7 participants were located and completed the follow-up survey. 
 
Cost. SBRHA maintained historical cost data for all participants in the study. Medicaid costs 
were compared for the year preceding the Feldenkrais intervention and for one year following 
the end of the intervention. Costs were compared both before and after the intervention. 
 



 
5 

D.Bearman & S.Shaffarman/Feldenkrais Research Journal 1 (2004) 

RESULTS 
 
Demographics. With regard to age, sex, race, marital status, and level of education, there 
were no significant differences between participants in the Feldenkrais program and those in 
the 12 comparison programs. Ages were widely distributed; there were slightly more females 
than males; more than half were divorced. SBRHA members were slightly more likely to live 
alone. 
More SBRHA patients were unemployed and had been unemployed for longer periods of time. 
They had lower incomes, predominantly derived from disability payments. About three-
fourths of participants in both the SBRHA program and the comparison groups were involved 
in legal actions relating to their conditions. There were substantial differences between the 
SBRHA population and the comparison group in terms of the number of patients who suffered 
abuse as children or adults (Table I). 
 
Pain history. SBRHA patients reported having pain in more areas than in the comparison 
programs, suggesting that the pain experienced was also more severe. In addition, SBRHA 
members had been experiencing pain for longer periods of time. One hundred percent of 
participating patients experienced pain for over 24 months, compared to 47.2 percent in the 
comparison group. Fewer of the SBRHA patients were injured at work, yet SBRHA patients 
had a greater rate of unemployment. 
 
Table I. Patient background information. 
 
‘Category                                                      SBRHA                                Comparison 
                                                                        patients                                   patients 
                                                                         (n = 7)                                    (n = 365) 
Sexually abused as children 
Sexually abused as adults 
Physically abused as children 
Spousal/partner abuse 
Childhood rated as unhappy 

43 % 
57 % 
71 % 
57 % 
29 % 

9 % 
6 % 

9.5 % 
13 % 

13.5 % 
 
Prior to the program, SBRHA patients had received more treatment for their pain than 
patients in comparison groups. SBRHA patients also had a greater number of hospitalisations 
and prior surgeries for their current pain problems. Also interesting was the fact that SBRHA 
patients included fewer current smokers but alcohol drinkers. 
 
Perception of pain. Prior to the Feldenkrais program, 28 % of SBRHA patients reported 
excruciating pain. Some of the methods they had tried to ease their pain were acupuncture, 
heat, manipulation, counselling, exercises, and medication. At the conclusion of the treatment 
phase, no participating SBRHA study patients reported excruciating pain. 
 
Functional status. Patients treated in both the Feldenkrais program and in comparison groups 
reported an increase in their ability to walk, bathe, dress, use the bathroom, drive a car, end 
engage in sex without the interference of pain. Prior to the program, 14.2 % of the 7 
Feldenkrais program patients spent 9 or more hours each day lying down, and none post-
treatment. Pre-treatment, 74.2 % of the SBRHA patients were experiencing pain all the time 
when they walked. At the conclusion, that number had decreased to 16.6 %. At the start of the 
program, 71.2 % experienced pain while driving, decreasing to zero at the conclusion. 
 



 
6 

D.Bearman & S.Shaffarman/Feldenkrais Research Journal 1 (2004) 

Patient satisfaction. At the end of the Feldenkrais program, 100 % of the patients reported 
some level of improvement. This compares favourably with data of the NPDB which lists the 
general expectation of comparable improvement to be 55.5 %. Feldenkrais clinician-perceived 
patient satisfaction was nearly 80 % in the SBRHA group; in the comparison group, only 33.7 
% of patients were perceived by clinicians as satisfied. In both SBRHA and NPDB 
comparison groups, high percentages reported feeling less depressed, suffering less anxiety, 
and also being able to relax more. A higher percentage of patients in the SBRHA group 
reported that they were able to return to some of the activities they had participated in prior to 
their pain. In almost all areas related to quality of life and functional status, SBRHA 
participants showed significant improvements immediately following the program. 
 
Summary. Generally, the Feldenkrais participants showed dramatic improvements by the end 
of the program, with 80 % stating that they were completely or almost completely satisfied 
with the overall treatment. Participants’ health care visits decreased, and the cost of pain care 
was reduced. Furthermore, the cost of the study program to SBRHA was a small fraction of 
the cost of most standard pain treatment programs. Additionally, medication costs were 
reduced post-treatment (Table II). 
 
Table II. Patients using five or more medications. 
 
Group Pre-treatment Post-treatment 
Feldenkrais Program 
NPDB comparison groups 

14 % 
3.2 % 

0 
6 % 

 
An area of clear importance is the number of health care visits each patient had in a 12-month 
period. In the year prior to the Feldenkrais program, 71.4 % had more than 20 appointments 
with a health care professional, and the rest had 8-10 appointments. In the year following the 
program, 100 % had between 11-15 visits. Cost analysis of the Feldenkrais program 
documented pharmaceutical and outpatient medical costs of $ 141 per member per month 
(PMPM) during the 13 months prior to the intervention. For the 14 months following the 
program, costs were just $ 82 PMPM: This represents a 40 % decrease. The $ 54 PMPM 
savings shows that with this group, the SBRHA recovered its direct cost of $ 700 per member 
within 13 months. 
At the one-year follow-up, while participants lost ground in most areas of pain control, 
function, and quality of life, they were judged generally healthier than at intake. 
 

CONCLUSIONS 
 
While this preliminary inquiry represents an uncontrolled, unblended investigation, the results 
were very promising. Whether they were due to a placebo effect or to some more specific 
scientific explanation is largely irrelevant. Physicians are often frustrated by chronic pain 
patients’ unresponsiveness to conventional approaches. Such patients often feel neglected and 
become angry and resentful. This program provided SBRHA and its physicians with an 
opportunity to affirm to our patients that we recognize that their perception of pain is real. It 
demonstrated to them that the clinic is willing to go beyond the normal scope of Medicaid-
covered benefits to intervene positively. The afflicted patients gained from both the treatment 
modality and the opportunity to be exposed to therapeutic touch with providers who are 
reassuring and positive about the modality’s ability to diminish pain and facilitate healing. 
It should be noted that although this is a Medicaid study population, pain problems are 
ubiquitous in today’s society. A July 1993 report on the cost of migraines notes that over 11 



 
7 

D.Bearman & S.Shaffarman/Feldenkrais Research Journal 1 (2004) 

million Americans have migraines, which cause moderate to severe disability (7). The annual 
lost productivity costs due to migraines are estimated at $ 6,864 per employed male and $ 
3,600 per employed female (8). A study of migraine sufferers showed 48 % had one or more 
ER visits, with 15 % having five or more ER visits in one year (9). Our study suggests that the 
Feldenkrais Method may favourably influence these numbers since two patients in our study 
group had migraines. 
 
Acknowledgement. The authors gratefully acknowledge the efforts of Shelley Tregembo and 
Susan Horne, M.Ed. who prepared the initial report that analysed program results and NPDB 
data; Carlos Hernandez who organized and analysed cost data; Laurie Wilson, RN for her 
assistance in planning and implementing the project; Marisol Alvarado and Jeannine Arthur 
for proof-reading; and Bernard Unterman, Lac, and Roger Jahnke, OMD, for editorial 
comment. 
 
 
 

REFERENCES 
 

1. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. 
Unconventional medicine in the United States: prevalence, costs and patterns use. N Eng J 
Med 1993; 323:246-252. 
2. Eisenberg DM, Davis R, Ettner SI, Apple S, Wilkey S, Van Rompay M, Kessler R. 
Alternative medicine use in the United States, 1990-1997. JAMA 1998; 28(18):1569-1579. 
3. Fontanarosa PB, Lundberg GD. Complementary, alternative and integrated medicine. 
JAMA 1997; 178(23):2111-2112. 
4. Berman GM, Singh BK, Lao L, Singh BB, Ferentz KS, Hartnoll SM. Physician attitudes 
toward complementary or alternative medicine: a regional study. J Amer Board Fam Prac 
1995; 8:361-366. 
5. Cimon M. New life for old remedies. LA Times 1996 Feb 1, Selection: Part A, Column 
one. 
6. Peletier K, Marie A, Krasner M. Haskell W. Current trends in the integration and 
reimbursement of complementary and alternative medicine by managed care, insurance 
carriers, and hospital providers. Amer J Health Promotion 1997; 12(2): 112-122. 
7. Migraine. Glaxo Welcome 1993. 
8. Prevalence of Chronic Migraine Headaches – United States 1980-1989. Morbidity and 
MortalityWeekly Report, May 1991; 40:331,337-338. 
9. Steward WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headaches in 
the United States: relation to age, income, race and other socio-economic factors. JAMA 1992; 
267:64-69. 
 


