Yeah. Well, thank you for all that. Yes. Basically, it was just needing some home education material. And I felt like I wanted to make something that was more authentic, that used language that felt more authentic to me, and have it readily available, right? So we all print out home exercises for our patients, but there is not anything available for pain neuroscience. So it was pretty simple. I found that I kept writing out the same breathing exercise over and over and over again, and thinking, I think I could streamline this. I think I could make this easier. Um, so that’s where it came from.

So just the natural repetition of practice that happens with all of us, right? Like, you know, how often are we printing out, you know, a squat exercise, right? Right. So for you, it was, cause I know you’re, um, very interested in pain education approaches for you. It’s like, well, I’m using pain education. I’m using it more and more.

Correct.

And I’m noticing that I’m talking about and giving handouts over the same thing. And yet there really weren’t, I mean, there were some handouts out there in some ways, but what you’re saying is you wanted something that was right, a right fit or a best fit for you and the patients that you’re seeing.

Exactly, exactly. And Right, I wanted it to be personalized, but also reproducible so that I didn’t have to do it again, each time. So kind of like a template, which we all do with all sorts of things. And then I started to realize, oh, I think this is quite useful. And maybe other people could use this as well.

And tell us about, just so we have an idea, tell us a little bit about the practice setting that you’re in and how, what that’s like and how you function. I think it’ll help people understand how the book kind of fits into how you practice and where you practice.

Sure. Yeah. So I practice at a small outpatient facility in Burien, Washington called Pain Science Physical Therapy. It’s privately owned and I’m one of the physical therapists there. I originally started working there because I really liked the practice model. And I thought pain science was interesting. And then as I’ve been there longer and longer realized there’s a great need to be proficient in pain neuroscience education and treating these patients. Cause you’re already treating them and they’re in your clinic every day, but we can get better at treating them.

Pain Management Physical Therapy

Right. And the physical therapists in the practice all have somewhat of a very similar approach to treating obviously both acute and chronic pain conditions. Is that right?

Correct. Yeah.

Yeah. So how did this project change or evolve as you start to work on it? Because I’ve written longer books that are almost 400 words. I’ve written some smaller ones that are a hundred. Each one is, you know, kind of a labor of love. And as I mentioned before, it’s not easy to get it distilled down into those 24 pages. So how did this evolve as you started to, you know, take that idea and cultivate into something that is real and tangible?

Sure. Yeah. I mean, it did exactly what you just described. It mushroomed into a very large project and kind of even, you know, just really nebulous thoughts. And I wasn’t sure where I was going at some points and then it distilled back down and some ideas got shelved for another day and some things got sort of integrated into my practice and then other things turned into a workbook. But I think, you know, it came from just this basic idea of why am I writing this exercise, this breathing exercise down over and over and over again to can I create something that’s interactive that allows patients to have a larger part in their treatment. It also helps guide clinicians in the treatment of chronic pain and saves time and energy in the clinic.

Yeah. So give us an idea, cause as you mentioned, some things kind of hit the chopping block and were edited out. Give us an idea of what you thought was important, what’s included in the book itself.

So the main lesson of, okay, why do we even have chronic pain? So overview on the nervous system’s role in chronic pain, and then some practical exercises relating to most of the topics in there. So it might be developing a mantra is one aspect of it, breathing exercises or calming tools. community, talking with patients about how to find their community or identify the importance of community, and then how to foster that within themselves and their lives. Just a brief overview on brain exercises, which I was not sure if I was gonna keep it or not, but I ended up keeping it, and I’m glad, and I can tell you why later. And then a little bit on sleep and nutrition and exercise. So trying to be, yes, exactly lifestyle. So trying to be comprehensive without being a manual or, you know, a textbook anything like that. And each of those things, like I mentioned, have a practical exercise with them. And then also blank pages for the patient to almost journal in. I’m a big believer in journaling and writing as a tool for learning and understanding your own thoughts and feelings. And so I wanted to incorporate that in there as well.

So you mentioned there’s, there’s writing prompts in this workbook. So how are you currently using it or how are the ways that you’re using it? Is it that you’re just giving this workbook to your patient when they come in on their first visit, or are you sitting down at specified times and treatment sessions to go through specific content as you see is a fit for the person with pain?

Mm-hmm. It’s been used a couple of different ways. So we just got the hard copies recently. And so we are going to start selling them. And so that will be one way that we’ll be using them. But right now in practice, I’ve been taking it on, you know, maybe visit one, but usually visit two or three and going through those areas with the workbook with the patient and stopping in the spots where I’m really wanting to focus with them on that day. So giving the education about that particular topic and then showing them the prompt and, and telling them, you know, I want you to write down what you think. I want you to take this home with you. This is yours. I want you to write on it and think about it and bring it back.

Do you have the book there? You can kind of hold up and show us.

I do. It’s so cute and pretty.

Yeah. And so. It looks great and I you know I’ve seen a couple of different renditions of this so nice and user friendly. So, what are patients responses to this so again like it’s really interesting because I’m sure it’s common in your practice that a lot of people with chronic pain. You’re not the first physical therapist they might be seeing. Right. So they’ve been given, you know, a single piece of paper with like a stick figure on it to, uh, you know, do two sets of 10 of a leg raise. Right. And here you come in, you know, armed with all these pain science tools in your brain, but also this beautiful workbook to share with them.

Yeah. At first they’re surprised, you know, they say, oh, that’s nice. And then I say, yeah, I wrote it. I made it. And then they’re kind of even more surprised, because I think, you know, they are expecting, even though they know this is sort of quote, unquote, different physical therapy, just by the name of the practice pain science physical therapy. But they’re still sort of expecting you to come in and be like, Okay, yeah, let’s do some leg raises and clamshells and call it a day. So I think they’re surprised at the level of attention that we give them. And then also, yeah, surprised that Oh, my physical therapist made a workbook because there was a need. And so then I think they’re also interested, curious, maybe even a little nervous about the personalization of it, right? When I say like, I want you to write in this. This is for you. I want you to write about your experience, but also empowering because they’re able to look through it and then ask questions. And so this is what I was alluding to earlier. I have a patient who often they’re referred specifically for pain education by providers in the area. And this person, person was flipping through the book and I wasn’t ready to talk about brain exercises with her, but she was pointed right to him and was like, I want to do this. You know, this is different. I want to do this. So it was a great gateway into her being able to direct her care, even though she didn’t know what those brain exercises were.

Yeah. I love that. And we know that if a patient or someone with pain, a person with pain, um, chooses something they’re more likely. to adhere to it and engage with that long-term. And I think there’s also a bit of a power differential that I think is really important to point out to people that you’re giving people this book. So you are giving them some information, but you’re not necessarily instructing them. They’re actually, they actually have the ability to choose the care that they want, which is completely different from, you know, probably 90% of Chronic pain centers out there that people come in and they’re somewhat of a passive recipient in their, their care, so to speak.

Correct. Correct. I mean, in a really simplified way, it’s almost like a menu at a restaurant. And instead of me ordering for someone, I’m saying, here are your options. Here’s what’s good here.

What sounds good to you, which one interests you and which one would you most likely like to try today? Basically.

Yeah.

So what have your colleagues had to say both? I don’t know if you had shared it with colleagues, both in the practice setting you work out and maybe outside the practice setting you work.

I’ve mainly, yeah, I’ve shared it with a couple of colleagues from PT school, but otherwise it’s been mainly in the practice and they’ve been very helpful because through the development of it, I met with them as a group and asked for feedback, which was part of the expanding phase of the project. And it was great, got lots of really good feedback, positive response from it, people were excited about getting to use it. And in the clinic, people will come up and say, Oh, you know, before it was on a just a printout version, they’d say, I printed out your workbook, or I printed out this page from your workbook, and my patient loved it. You know, I got one comment that someone didn’t like a quote that was in there. But It can’t make everyone happy.

That’s true. I mean, there’s definitely parts of pain that are so personal that it’s really difficult for us to, um, take all things into consideration, but exactly what’s there is, is definitely, um, very, very useful. So what’s the challenge of making a workbook? Cause you know, you look at it and you’re like, Oh, 24 pages. I can do that. I can just print out 24 exercises. No, no big deal.

Yeah. Yeah. Well, One totally unrelated, but big team related challenge was time. I started this project in the winter, which is great. Um, but I live in Seattle and the summer is beautiful and the summer is when you garden. And I found that it was hard to prioritize doing it during garden season. So, you know, just a little, I’m a human too.

Yeah. Cause the projects take attention, right?

Absolutely. Absolutely. So maybe my best project making seasons will be in the winter. But the other part was picking what stays and what goes and making it both authentic to me using language that I use with my patients through pain education, but also making it universal so that, you know, colleagues all over the country can pick it up and use it with their patients. Because I think there is a shortage of easy to use provider patient material. And so I did want to make it universally useful. So I think that was probably the biggest challenge of making it complete without making it expansive. I mean, it’s impossible to make it complete. Pain science is a huge topic, and it’s constantly changing as well. And I’m definitely not the expert, you know, holder of all the knowledge on that for sure.

The Process to Create a Pain Management Workbook

Tell me what the editing process was like because when you’re taking a large body of knowledge like pain science and pain education, and distilling it down, oftentimes, you can just throw out a whole topic. So, okay, that’ll be for book number two, let’s say, but how do you even take, for example, breathing and what’s the process that you went through to figure out, okay, this is what’s important. This is how long it should be. This is not important. I think that editing process is really key in something like this.

Agreed. Well, obviously you were helpful in it through the Pain Innovator Project. Um, and really trying to minimize how much went onto the page thinking, you know, four to five key points, takeaway points that help somebody understand why is this important? How can I do it? And what is it going to do for me and leaving it at that? I mean, there’s so much information out there that if somebody wants more information, we can talk about the diaphragm and the pelvic floor and the core muscles. but it doesn’t need to go in the book.

Just a few key points each chapter, right? Exactly. I’m wondering if that has changed the way you practice. Like, have you started to just say, wow, in the past I was, you know, just trying to do everything or trying to give people so much information. And now this book has made me realize or helped our clinic realize that maybe with some people, especially less could be, could be more for them.

Agreed. Yes, I think I think more frequently about that, especially in my communication, both spoken and written. There’s a desire to over explain yourself, I think that’s natural, but people get lost in it. And you can be clear and say what you mean in less words.

So now that you have this one project under your belt, complete, printed out, you have a nice workbook there. Do you have ideas about other projects, similar projects or different projects?

Yeah, similar and different. I don’t have any more ideas for workbooks, but who knows, maybe more will come. I do keep thinking about storytelling and narrative therapy. Um, so maybe something will come out of that as it relates to physical therapy and pain and movement. Um, I’m about to start some workshops. So. Sort of the course of over the, just over the past couple of years, I’ve really started thinking about community impact and how can I make a difference in my community? And I think. Working for a community based clinic for sure. We do that, but you know, it’s always one-on-one. And so there’s a limit to how. much effect you can have. So I brought the idea of workshops to the clinic owner, and she was totally on board. So I’m doing six week workshops, they’re paid, so patients sign up, or people from the community sign up, and they’re going to be on different topics. So I’m starting the first one in November, and it’s going to be on balance, pretty generic, you know, but very important topic. And then After that, in January, I’ll do another workshop, and it’s actually going to be on the workbook. So I’ll have a group class. We’re limiting it to about 10 people, and we’ll go through the workbook and see how that goes. That will be an interesting way of testing out the workbook in a group setting, but I think there’s a power to being in a group with other people who are in your similar situation that I’m really excited to be a part of.

Measuring Outcomes in Pain Management

And with that group, do you have any, um, ideas of like measuring some outcomes related to, to the book, maybe some, you know, pain education outcomes, things like that.

Cause I could do that. Yeah. Get, get scientific on it.

Yeah. A little pre and post. I have some ideas for you, of course, pre and post more than 10 questions is always, always nice. But just to say, Hey, I took a group of 10 people through this and, um, here’s what the outcomes were. Right.

Sure. Yeah. Yeah.

In addition to their positive experiences that they can just give you in a little quote or something like that. It’s nice to have that kind of data there. What’s the one thing that you learned that you were surprised about just from the whole creative process and then using it with your patients and clients?

That we need lots of ways to communicate. Very, you know, concepts of pain education, we need lots of ways to communicate them and that we have to personalize it. And it was something I already knew, but in trying to make new language for how to communicate with people, I think I felt it even more. And so, and that, and also just expanding even more consideration for a patient and, and where they’re coming from their community, their lived experience up until this point. I think I think about that more and maybe more is more in the forefront of my mind when I’m treating the person now.

You feel like the book accounts for that a little bit, or that’s really something that we really have the skill around when, when working with someone.

hopefully a little bit of both. Yeah, I hope the book encourages providers to think about that and to talk about that and expand their own knowledge on it. You know, we can’t be experts in everybody’s lived experience, but we can ask them about it and we can believe them when they talk about it or we can know, we can educate ourselves as best we can and know that it affects how somebody is gonna show up in your physical therapy clinic.

Who Can Benefit from a Pain Management Workbook

One of the things that someone might be saying is, well, I have a herniated disc, like, is this book right for me? Or I have a CRPS, is this book right for me? So maybe you could just kind of explain and just talk briefly about the types of patients that you’ve seen, the variety of conditions that you’ve seen that you’re currently using this workbook with.

Sure. It’s definitely appropriate for anybody with pain, specifically chronic pain. I would say it’s most targeted at those with conditions like CRPS, fibromyalgia, chronic fatigue syndrome, chronic low back pain, chronic neck pain, even just deconditioning due to pain conditions. you know, definitely, definitely that is the population that it’s targeted towards, though the concepts are pain education concepts, which can be widely applied.

And do you see this workbook being able to, so we’re talking mostly to physical therapists now, but do you see this workbook being able to be applied and cut across, let’s say the physical therapy specialties like orthopedics, neurology, women’s health, Can you see various professionals using it in their practice?

Absolutely. Yes. I mean, I’m in the outpatient orthopedic setting, but you could for sure bring it into the acute care setting. Yeah. Rehab, skilled nursing facilities, neurology, orthopedics, for sure. Everything you mentioned. It’s because it does address the universal experience as it relates to pain.

So I want to thank Maria for joining us this week on the Healing Pain Podcast, talking about this new treatment tool for pain neuroscience education that you can use with your patients. Or if you’re someone with pain, you’re looking for a quick and easy resource that’s effective. Make sure to look up Maria and the Pain Freedom Workbook. Maria, let everyone know how they can learn more about you and access the workbook. 

Absolutely, yes. So you can find me on the clinic website, which is www.painsciencept.com. And the workbook will be on the website and you can pay to download a version of it that way. And if you’re interested in a hard copy, you can always send me an email. It’s dr.maria, dr.maria at painsciencept.com. 

Great, of course. Say that again. 

Thanks so much for having me, Joe. It’s been great to talk with you. 

Great. Well, of course, include all those links on the show notes at the Integrative Pain Science Institute, both the links to Maria’s practice, her email address, and I’m also going to include a link to Maria’s LinkedIn page. So if you’re interested in linking with her as a professional, you can do that as well. Hey, it’s a pain freedom workbook. I know, you know, someone who has pain or, you know, a practitioner has pain. So make sure to share this episode with your friends and family on Facebook, LinkedIn, Twitter, Instagram, wherever anyone is talking about how to treat and manage chronic pain. I’m Dr. Joe Tada. Thanks for joining us this week and we’ll see you next week.