Book review and interview : The Chronic Pain & Illness Workbook for Teens by Rachel Zoffness

Thank you Net Galley, New Harbinger and Rachel Zoffness (clinical psychologist working with teens coping with pain ans medical issues) for this amazing book! I must confess that if the book first caught my eye, it is because I am chronically in pain (though I’m not a teen any longer!) and I believed I’d learn a few tricks to help with the pain.

What I really liked about The Chronic Pain and Illness Workbook for Teens is that it is based on mindfulness practices, which of course are perfect for teenagers but for everyone actually.

It is all about breaking the pain cycle, feeling better, getting your life back and that is definitely what people in pain are striving for.

I particularly appreciated the chapters about pain and your brain, emotions and pain.

The advice is clear, easy to give a try to, and all in all logical: for instance transforming thoughts to transform pain as well as avoiding negative self-talk… Thank you for the apps, websites and additional resources which are also very helpful.

So if you want to break the cycle and improve your quality of life, this book is for you! I highly recommend it. 

Biography of the author

Rachel Zoffness PhD is a pain psychologist, author, medical consultant, and educator specializing in chronic pain and illness. An Assistant Clinical Professor at the UCSF School of Medicine, she teaches pain education to medical residents and interns. Dr. Zoffness serves on the board of the American Association of Pain Psychology, where she founded the Pediatric Division. In 2019 she published The Chronic Pain and Illness Workbook for Teens, the first book of its kind to offer biopsychosocial, CBT-based pain management techniques targeting youth, parents and treatment providers. Dr. Zoffness founded a private practice in Oakland where she treats pediatric and adult chronic pain patients. She was trained at Brown, Columbia, University of California San Diego, the NYU Child Study Center, the Mindful Center, and Mt. Sinai-St. Luke's Hospital. She collaborates with UCSF, Stanford, the Osher Center for Integrative Medicine, and consults on the development of international pain programs.

      Interview

      What inspired you to write this book?

I wrote The Chronic Pain and Illness Workbook for Teens for multiple reasons. First of all, every human being experiences pain at some point in his or her life. However, in general, people know very little about pain. Pain has historically been conceptualized as a biomedical problem, due exclusively to biological issues like tissue damage or system dysfunction. However, what we now know, and have actually known for decades, is that pain is biopsychosocial – a product of biological, psychological and social factors. All three of these domains interact to produce pain. Psychological factors include emotions (e.g. stress, anxiety and depression, which all amplify pain), thoughts and beliefs, prior experiences, and coping behaviors (e.g. withdrawing, avoiding activity, etc). Social factors include socioeconomic status, access to care, culture, race, religion, friends, family, social support, and larger environmental context. It’s amazing to me that we all have pain and yet it is so poorly understood and so infrequently taught. This lack of understanding is why America is currently in the midst of an opioid epidemic. A recent journal article reports that 96% of medical schools in the US and Europe have zero compulsory, dedicated pain education! My second goal in writing this book was to spread the word about how pain works in the brain, as well as to offer nonpharmacological, biobehavioral approaches to pain that are evidence-based and rooted in the scientific literature. I specifically wanted to write a workbook for youth, since this population is largely ignored. While there are a ton of resources for adults with pain – dozens of workbooks, self-help books, even books for parents of kids with pain – until now, there were no resources specifically for teens living with chronic pain and illness. My third goal was therefore to empower youth to tackle their own symptoms, to feel agency over their own bodies. Ideally this book will be used by teens in conjunction with a therapist or health provider, but at least now the tools are out there on Amazon for anyone to find. Finally, I wanted to create a workbook that could serve as a tool for any health provider to pick up and use. There are very few explicit, step-by-step pain-management protocols for pediatric providers, and outpatient psychotherapy is very expensive and not accessible to all patients. So this is an inexpensive option for health providers, parents and teens who want more resources.

 Could you share some anecdotes about writing it with my readers?

I’ve always wanted to be a writer! As a little girl, an introverted bookworm, I told my parents I was going to be a writer when I grew up. But I also fell in love with neuroscience, biology and pediatric psychology along the way. In college at Brown University I studied science writing, neuroscience and psychology. At Columbia University I got a masters in Psychology and Education, then a PhD in Clinical Psychology at the University of California San Diego. Now I’m what is known as a “pain psychologist,” a psychologist who specializes in chronic pain and illness. I love it. But writing has been missing from my life for many years. Because there are so few resources for youth with pain, I started creating handouts for the teens and parents in my practice for them to take home. It was an opportunity for me to do some science writing, which I really love – to take complex, scientific concepts like pain neuroscience and to make them kid-friendly. As most people know, change doesn’t always occur during the hour you’re with your doctor – it often occurs in the space between sessions, and these handouts were an opportunity for my patients to work on their pain even when I wasn’t with them. They were very successful, and soon I had so many handouts that they became a workbook that I stapled together and gave out. These handouts include pain neuroscience education, pacing for exercise and activity, mindfulness, relaxation strategies, distraction strategies, sleep hygiene, nutritional tips, even a plan for getting back to work and school. It occurred to me that I need not restrict these resources to the teens in my practice, and that I could potentially make them available to struggling teens all around the world. I researched publishers specializing in health and medicine, particularly adolescent-self-help, and found New Harbinger. They are amazing. I’d read a ton of their books in grad school so knew them well. I pitched my workbook to their acquisitions editor and she wanted it! I remember exactly where I was when I got her acceptance email: I was at a wedding in New Orleans, and did a little dance. It was a huge moment for me to finally get published. I’m now working on a second workbook for adults.

      Is it easy/ difficult to find time to write?

Yes and no. I think a lot of writers, like me, also work full-time. I’m admittedly over-committed, but right now I love everything I do. I run my own private practice treating patients with chronic pain, which luckily means I get to set my own hours and take time off as needed. But I’m also an assistant clinical professor at UCSF Medical School where I teach pain neuroscience education to medical residents, and we’re collecting data for publication. I write articles for scientific journals and submit abstracts to conferences. I give talks and trainings locally and internationally (the Bahamas in February if anyone wants to come!), and now I’m working on this second book. I also sit on the board of the American Association of Pain Psychology, a multi-disciplinary organization bringing together providers of all backgrounds (psychologists, social workers, physical therapists, physicians, nurses, etc) to educate, network, collaborate, and promote the biopsychosocial model of pain management. It’s a lot. The only way the writing gets done is because I carve out time for it. I write every day. I don’t always get to work on the book every day; but I’m always writing about pain science and that generates and solidifies ideas that ultimately go into the book. I’ve established a dedicated writing schedule wherein I write 3 mornings a week – sometimes it’s just editing, sometimes just brainstorming, and sometimes getting words down on paper – and this often spills into the weekends. What’s most helpful is that my publishers have given me “batch” deadlines, so two chapters (which equals one batch) are due every few months. If I have a deadline and need to get a lot done in a short amount of time, I’ll take my laptop somewhere remote, where I can’t get distracted by people or the internet, and sit on a blanket up in the Oakland hills. By now I’ve learned the rhythm and amount of time that I need to get each chapter done, so having done one book really informs how I manage my time for this second one.

      What are your favourite novels? authors? Why?

I was an avid reader as a child so have a zillion favorite books and authors. My most favorite is The God of Small Things by Arundhti Roy. The story is compelling, but even more astounding is the language she uses to weave her tale. She is a word-magician and her sentences are so stunning that I find myself reciting them even years later. I love Dandelion Wine by Ray Bradbury, East of Eden by John Steinbeck, Toni Morrison novels, and everything by Oliver Sacks. I recently enjoyed The Brain that Changes Itself by Norman Doidge, all about the power of neuroplasticity, and Soft Wired by Michael Merzenich. I love the Harry Potter series; JK Rowling inspired an entire generation of children to line up around the block to wait for a book – a BOOK! – to be released and read eagerly at midnight. In this era of screen- and-videogame addiction, that is True Magic. Admirably, her books are captivating and complicated enough to ensnare even adults. One of my favorite HP-related memories is of riding a silent NYC subway car in Manhattan in the early 2000s, every seat taken by an adult absorbed in a Harry Potter book. I also read a lot of the pain work written by Lorimer Moseley and Adriaan Lowe, who are great communicators. I really value science writers who are able to take complex, seemingly overwhelming concepts and translate them into user-friendly, accessible language. As an educator I believe we need people who have that gift of words, because at the end of the day, a good teacher is really just a good communicator.

      Your last word?

One hundred percent of humans experience pain in their lifetimes. Up to one in three youths live with chronic pain, and over 100 million adults in the US alone. Big Pharma has a billion dollar budget to market pills like opioids for pain, but we know that this isn’t the answer for long-term chronic pain treatment. If it was, incidence of chronic pain would be going down – not up – and pain sufferers would be getting better. That’s not what happening. This doesn’t mean that we should rip pain pills away from long-suffering pain patients, because that isn’t fair either. But pain isn’t biomedical, it never has been, and we need to stop treating it this way. The only way things will change is if physicians, medical schools and hospitals adopt a truly biopsychosocial model of pain; hire multidisciplinary treatment teams that include pain psychologists, physical therapists, biofeedback experts, and other integrative providers; and prioritize nonpharm approaches to pain medicine as highly as they prioritize pills. There’s also another way: perhaps we can educate enough patients – you, me, every single person out there living with pain – and create a demand for psychosocial, integrative approaches to pain medicine. As of now, biobehavioral treatments like Cognitive Behavioral Therapy and Mindfulness-Based Stress Reducation, both considered evidence-based pain treatments, are not reimbursed by insurance. This makes them unfairly expensive and therefore inaccessible to consumers. The system is broken. Here’s my plea: learn more about pain, spread the word to friends and providers, and demand that your physician refer you to nonpharmacological, biobehavior approaches like CBT, mindfulness and biofeedback. My patients, by and large, get better. They get out of bed, get back to their lives, and change their pain. These techniques are real and they work! Have hope!

More information about me and my practice can be found on my website, zoffness.com. The Chronic Pain and Illness Workbook for Teens is available on Amazon, and a second workbook for adults is in progress. Follow me on Twitter @drzoffness and on Instgram @TheRealDocZoff.

Thanks for interviewing me and for taking the time to read my book J

Thank youRachel!!!!!! ! :)