5 Steps to Transform Pain Care in Your Community

Let me be brutally honest. If you're waiting for the healthcare system to fix itself, or for a pain psychologist to magically appear in your clinic and save your patients, you're probably gonna be waiting forever. We are drowning in need, and most people in pain will never get what they truly need unless we step up locally, urgently, and with purpose.

This is the Modern Pain Podcast with Mark Kargela.

This episode is a roadmap. Five things you need to do, not someday, but now to transform how pain is cared for in your community. Step one, step up. Recognize the need and take action. I don't think this goes with surprise, but there's a massive unmet need for quality pain care. Most communities around us don't really have significant access to a pain program, and I'm not saying you need to be able to form a massive multidisciplinary pain program. It's just you need to be able to have the skills to connect the dots between the body and the mind to psychologically informed care. We all know our pain psychologists are amazing. I'd love to duplicate them and triplicate them and put them all throughout the country, but unfortunately, there are nowhere near enough of them to meet demand. So if you're a clinician in a community, you're in the best position possible to make a difference. Don't wait for somebody else. You don't need to launch that entire pain program. Really, we start with an N equals one in your program. Every patient is an opportunity. Are you gonna be that clinician who recognizes the psychosocial things that you have, your lovely screening tools. You're being evidence-based with your screening tools, but you don't know what to do with it. You don't know how to construct, the conversations help connect the dots for the patients, and most importantly, have that translate to some changes in that person's life. We know the system's broken. We have rushed visits, dehumanized care, people being reduced to scans and lab values. We got clinicians burning out and patients who are stuck. So in the end, this step is about choosing to lead and not waiting for permission or waiting for somebody else to step in and save the day, be the change you want to see in your community. Okay number two, build a financial model that works for you. If you want sustainable care, it's gonna require sustainable income. You can't serve well if you're broke or burnt out, there's many models with this, and this is gonna depend on where you practice the system you're in, and many different factors. So I don't have the answer for each of you, but there are so many options out there. Cash based models, hybrid models, insurance friendly approaches where you can have insurance reimbursement for what you're doing, subscription or community supported models. What matters is your alignment does, it's the model serve you and your mission of what you're trying to accomplish. We're looking at models where we can have some premium services in a clinic. That can support some of the folks that don't have the ability to pay for services. So maybe you use a Robinhood type model where the folks that are able to pay for more premium services that you offer can then support the ability to provide low cost services, maybe even pro bono services for folks in your community. Now, obviously it'd be nice if we could produce. Pro bono services and sustain it. But oftentimes, unless you have significant grant funding or community funding it's gonna be hard for that to fly. So you need to find some ways to make your model work for you. So you need how to learn how to price, communicate the price and deliver value in a way that supports your lifestyle and impact, right? I think we do have a tendency as healthcare professionals to not want to charge for what we are worth. And I'm not saying we need to charge significantly where we're putting our patients in financial distress, of course not. But we do need to be willing to value what we do and charge for the value we bring to an encounter when we see such amount of waste in healthcare, so many programs and interventions that are costing our patients thousands upon thousands of dollars. It shouldn't be that hard for us to step up and say, I have something that is low risk, that can help somebody get their life back. So we need to be willing to develop financial models that work for us. Next step, and this is one, I think as healthcare professionals, I know I wasn't taught at all and it's learn how to market without selling out. cause that's the fear, right? People feel dirty, sleazy, they don't feel like doing something that's the altruistic way that they like to operate. To me. If you're not marketing your program, you're doing your community a disservice, and I'm not saying, again, a full pain program. You're not marketing your services of the ability to help somebody reclaim their life. Then you're being selfish. You're being somebody who is not communicating your ability to help somebody. To me, that's what marketing is positioning what you're doing, letting people know about what you do, how you do it, and if you're a good fit for them. You have a lot of stories in your clinic as you're starting to get some of these folks navigating pain stories more. Efficiently changing their lives. Those are your best marketing, right? So you could use different strategies in your marketing where you can engage a community. I know some clinicians are doing Facebook groups and different groups or community groups where they're having patients in pain gather together, share stories, social learn, and peer learn with each other, so they're able to teach and move each other forward. You can create community type groups that aren't some of the things we see on social media where we have people just focusing on the negative and the depressing and the anger and the emotion charging things, which we know. Although people have every right and reason they give you frustrated, angry, sad, depressed, and everything in between is if they bathe themselves in that day after day, and that's the story that they consistently engage in on social media, it's probably not gonna move them forward. And it's definitely not gonna create a nervous system, a body system, and our homeostatic system, stress systems that are gonna be in a situation where they're not gonna be having more pro-inflammatory, pro-pain type behaviors. You wanna also be able to produce. Story-driven content, right? Highlight the success stories and struggles and progress of your patients. Now, obviously you need to do that with HIPAA guidelines and different privacy guidelines in mind, but share the stories. Maybe you de-identify some of the information. You just share the stories that you're having. We need to share the stories of the changes people are making. That's half the reason I that is the reason I make the episodes we have in our podcast where we share stories of patients who are. Making massive changes that are really turning the corner in some very difficult pain situations. We want to show the public out there that ideally they look at these stories and say, that sounds like where I am right now, and look at how good this patient's doing. And they're all of a sudden open to maybe trying some things with you to try to change their, the course of their life. You also wanna be skilled with your ability to network with and partner with your referral sources. And this doesn't just have to be physicians. It could be massage therapists, it could be fellow physiotherapists. If you're a physical therapist, it could be occupational therapist, it could be psychologists in your community that maybe they're just strictly telling the story around the mind and people aren't getting the connection of how the mind and body are together. But you need to have clear messaging as you're starting to reach out to patients. Or referral sources that shows how you help people reclaim their life, and most importantly, help the clinicians out there to have somebody who can be a resource for some of the frustrating cases that they don't feel like they're able to help. They feel like the patients are coming back over and over again without significant changes in their life. They might have some temporary changes in their symptoms. And of course these folks want to help patients and patients are frustrated, clinicians are frustrated. You can be that person to help somebody navigate that frustration. And recognize too marketing's a skill. And like any other clinical skill, you gotta be learned. You gotta get reps into it too. You gotta get comfortable maybe getting on social media, which I'm not a huge fan of social media, believe it or not, even though I pepper it with my face and my videos and things like that. But in order to be have people in your program, they need to know you exist. They need to know that you're somebody out there that might be somebody who has a solution for them. So you need to gain skills in social media doesn't mean you have to be on video. Some people are more written word content. That stuff can still get views and get people to engage with it and start getting yourself seen as a authority or somebody they can trust in navigating their pain situations. Find a mode of social media or marketing that works for you. Some people are more in person marketers. They want to go to your local chamber of commerce. They want to go to local community groups, and that's great too. I think the more you can do, the more touch points you have with people in your community be it patient, be it clinician, the more chance you're gonna be able to spread your message. So you need to develop skills and strategies to do that. Number four. Get around people who are doing the work, right? CEU weekend courses don't launch meaningful programs. They don't change your practice significantly. I'm just saying from my experience, maybe you've had a experience where two days on a weekend made a massive shift in how you practice. and you feel like you don't need any ongoing feedback. That's great if that's for you, but for me. I needed much more than two days. I needed some ongoing support. I needed accountability and a community, and that's what the communities do, right? It's a like-minded group of people who are trying to do the same thing you're trying to do and they're supporting you. And when you're having difficulties taking that two day weekend stuff and applying it, you're not just left on your own Where the the last slide on Sunday's over and now I'm left to be on my own and figure it out. This is where community-based learning to me is really shines. It helps you be around people that can help you navigate the mistakes you're making, navigate the struggles.'cause they're probably making the same ones too. And when you have mentors and coaches in communities who've probably made the same mistakes that folks are trying to avoid making, it can help you shortcut your growth and really get yourself moving further along much faster. So it's gonna avoid this of isolation. You're gonna learn faster. You're gonna get real time feedback. How awesome is that when you can be working with a patient and then jump on an app and put in some of the details of the case and get feedback within hours of maybe a different way to approach it. A different way to construct a conversation, a different way to maybe help that patient connect the dots with the experience that you're sharing and their pain experience. You can borrow the belief and confidence from peers. I think a lot of times too, we feel like we have to be this all confident expert in the treatment room. I don't think if you talk to anybody who's done this, that they're gonna tell you that it always feels confident. They always feel like it's successful, that every interaction goes perfectly. I think be understanding that it's okay to not feel confident. It's okay to not feel like you have it all figured out. And it's okay to feel like you're navigating into a difficult conversation that's full of uncertainty and difficulty. So it's being able to implement and navigate into those difficult situations, into those. Uncertain situations and not just focus on expertise knowledge of I know this randomized controlled trial says this, and here's what my clinical practice guideline says. Those are all great. Nothing wrong with those. But if you can't translate it to a meaningful engagement with the person in front of you, it doesn't mean that much. So I would just say be. Mindful of how am I implementing this? Not just learning, am I just reading research articles, going to,, some courses here and there on the weekends, but nobody's helping me navigate it within my practice. To me, education needs to evolve the two day weekend course. I'm not saying it's completely useless, but I think we, if you really wanna get good at this type of stuff, you need guidance, you need coaching, you need supervision, you need mentorship, and it must be collaborative and continuous, not something that's just a two day weekend thing. I feel cohort-based learning where you're learning with a group of people in the same situation is the way of the future for sure. Number five, learn to deliver true psychologically informed care. And again, as I mentioned earlier. I see clinicians over and over again, and I was this clinician. I could recognize it. I could see the difficult emotions in my room. I could hear what difficult situations people were in. I could see that was massively impacting their situation. I just didn't feel like I had any skills to do anything about it. To help the patient connect the dots. And we still work in a healthcare system where somebody's gonna talk about your mind, somebody's gonna talk about your body, and nobody connects the dots for people of, like their mind and the world that's inhabiting. And all the difficulties and challenging things our patients and pain are going through are significantly impacting the stress systems, which in turn impacts your immune system, your gut health, all these different things. Sleep, stress, social engagement, all the things that we know, lifestyle medicine, and other things that are very impactful of somebody's pain experience. So this is deep in skilled work that requires couple things. C, compassionate communication. Behavioral change tools rooted in evidence, motivational interviewing. I think guided discovery where you're helping patients come up with their own answer and not just simply lecturing and dictating to patients. You're gonna have a flexible person-centered mindset, which those type of, communication strategies allows you to be flexible, to follow the patient and not just, dictate and be an expert. Patients have been through enough where they're getting lectured to, told what to do with little input. When you learn motivational interviewing and guided discovery approaches, you construct a shared expertise in your treatment room. Where a patient sees you as an equal and somebody who's on their team, not some dictator who doesn't listen, that doesn't understand their context, that doesn't understand all the horrible, difficult things that they've been through. So such a huge skill. And the other thing,'cause I get so frustrated'cause I can't tell you how many times a year while you're throwing the baby out with the bath water. I get the concern'cause it's a fair concern, right? That you're all of a sudden just talking to people. And that if people follow me around, I'm just apparently sitting on a couch. Just, exchanging stories about people's mental health. Now that stuff is all integrated within some very traditional bottom up things and you still need to be skilled bottom up. I do hear stories of clinicians who are strictly going to the mind body to through the mental health components and avoiding like, Hey, you still gotta move. Some of these tissues still are no perceptively driving the problem, and they might need some specific loading strategies or movement strategies to help them reengage and desensitize. Of course, it doesn't probably need to be the ridiculously overcomplicated Jedi level stuff that manual therapy training had gotten into. And thankfully for the most part, I see manual therapy moving away from that. But it's a skillset, you need to be able to understand with each patient encounter, how much bottom up versus top down mix do I need to have with somebody. I think another big issue you have is people think that this magical three month where things have now become chronic. Now let's get into the psychosocial components. That to me is not psychologically driven care. Psychologically driven and informed care is something where you have a process, whether it's a day old or a decade old, that can check in how the human is dealing with the pain experience they're having. You'll see people early on, and we, I know you've had people, if you're working with patients in clinic that have an acute injury, who are catastrophizing, who are freaking out, who are already shrinking life dramatically and maybe in a way that, we all have to probably shrink life a little bit after injuries and painful situations. Maybe they're reacting in such a dramatic and significant way that it's really moving them further and further away, and it's probably setting them up to more chronicity. Now again, different conditions require different adaptation. So I'm not saying there isn't a time where we have to shrink life, like I said, but I think if we can recognize and have a process that can take pain regardless of its temporal characteristics of acute versus chronic, and help determine if somebody's got any adaptive views and behaviors around it, then you can help people prevent becoming a chronic pain patient, ideally because you're treating it well acutely. In the end. You need to be a clinician or a coach or a guide that can guide somebody through uncertainty, complexity, and change. And we as clinicians can't simply just look further into more complex technical skills of how we can train our hands, or 15 ways to poke a needle into somebody, or new cupping strategies or new mobilization manipulation strategies. Some of these things I do and I'm not, again against them. If you're missing the elephant in the room, that it's probably not more techniques that you need to focus on tissues. It's being better able to focus on the human in front of you, and until you can develop whole person care, which not, and not just give it lip service where you're screening it. Oh yeah. I identify psychosocial yellow flags all the time. Are you doing something about it? Are you creating clinical encounters that help people connect the dots on those where they can see concrete examples of how it's affecting them specifically in, in their life and in their pain? To me, that's the skill clinicians need to develop. In the end you need to find folks that can help you develop these skills. Now this is exactly why I created pain practice os because I was tired of seeing. Whole person healthcare, psychologically informed care given lip service given maybe online course where you can watch some videos and maybe get a little bit of some quizzes. And to me, that doesn't give you the supervision guidance and mentorship that you need. So Pain Practice OS is all about teaching you how to deliver. These exact skills with people in your practice. You learn the skills and then you apply'em and then you get feedback, and you get coaching and you get guidance, and you get the ability to learn from people in your practice.'cause to me that's what's gonna translate from you becoming somebody who can identify psychologically informed care and factors that need addressing and actually address them and do something about it in a successful way. Stays within scope leverages some of the beautiful things we have in pain care and psychologically informed skills, acceptance and commitment skills, guided discovery skills, motivation or interviewing skills, and just being a good human being in practice. And I'm not saying people aren't being good human beings, but I think. We lose the humanity when we just try to strip people down to clinical practice guidelines and randomized control trials and forget this is a unique suffering human being that needs our attention, that needs our validation, that needs somebody who can step in as a guide to help them through it. We also help people develop marketing strategies and help them learn how to market and network to develop a pain program that has exposure and has visibility in communities. Amongst patient communities, amongst professional communities, that you become that person who's known to have a program that can help relieve the frustration of clinicians who are frustrated because they don't feel like they can help people. They don't have the tools like people are learning in programs like ours to, to help really connect the dots and help them make significant change. It also helps our patients, of course, who are cycling through treatment after treatment and not getting the answers or not getting the results that they want, and life continues to be small and not the way they want it. So we help that. We also have patients in our community who help keep us on task, that we don't lose the patient voice, that they help hold us accountable to not getting too into clinician minds and clinician mindsets and losing sight of what it really means to be the person in front of us who's struggling with pain and seeing life decrease. We also work on financial models, like what are the financial models that work for you in your unique setting and what your capabilities are, be it whether you work in a group practice, a hospital practice, a private practice, or anything in between. How do you develop some financial strategies that allow your program to be successful, sustainable, and something that can scale and grow and make bigger and bigger impacts in your community and beyond. So if that's something you're interested in, I'd love to have you join us in the program. My goal, we have 12 so far. My goal is a hundred over the next two years of getting people who are delivering this care in their community. I think this is something that is so sorely needed. I keep having conversations. I talked with Bronnie Thompson, my friend and colleague who helps me in the program, and we're hearing more and more stories of clinicians who are feeling burnt out. Frustrated they can't deliver this care. Frustrated that there, there's nobody who's supporting them to, to deliver the whole person healthcare that they know is so sorely needed in their communities. So that's why we created this community, this course, is to get the support you need and make the impact you want to have. If you look in the description, we have a link below if you wanna get on our waiting list. We're set to open up a new cohort soon. We'd love to have you involved, and I'd love to hear how you're making changes in your community or what are the changes that you feel like need to be made in our education and how we do more than just simply give this type of care lip service and actually embody it and do it on a day-to-day basis with real people and make real transformations. I'm gonna leave it there this week. I appreciate y'all hanging in with me until the end of the episode. Subscribe if you're not subscribed and we'll see you next episode.

This has been another episode of The Modern Pain Podcast with Dr. Mark Kargela. Join us next time as we continue our journey to help change the story around pain. For more information on the show, visit modern pain care.com. This podcast is for educational and informational purposes only. It is not a substitute for medical advice or treatment. Please consult a licensed professional for your specific medical needs, changing the story around pain. This is the Modern Pain Podcast.