Welcome back to the Healing Pain Podcast with Carey E. Rothschild, PT, DPT, OCS, SCS, CSCS
It’s a pleasure to be spending this time with you. In this episode, we’re talking about the latest in pain science and pain education with our expert guest Dr. Carey Rothschild. Carey is an Assistant Professor in the Department of Physical Therapy at the University of Central Florida. In addition to earning her DPT degree, she is also board certified in Orthopedic Physical Therapy and in Sports Physical Therapy and earned a certificate of achievement in Pelvic Physical Therapy. Her research related to running and the female athlete has been published in The Strength & Conditioning Journal, The Journal of Strength and Conditioning Research, Sports Health and the Journal of Women’s Health Physical Therapy.
In 2019, Carey received the award for Excellence in Academic Teaching from the Florida Physical Therapy Association. A big part of that was for her innovation in developing and teaching one of the nation’s first pain mechanisms and treatment and rehabilitation courses for both physical therapists as well as other healthcare professionals. In this episode, we’ll discuss the foundational and important aspects of pain science, pain education and the steps Dr. Rothschild took to create a course on pain science education at the university level. Also, how she has expanded the delivery of pain education not only for physical therapy students but also for other healthcare professionals such as social workers.
Before we begin, I wanted to let you know that Dr. Rothschild has joined the Integrative Pain Science Institute as a faculty and educator. As part of her joining, she has two offerings that I want to share with you. The first one is a free masterclass on pain science education. If you like what you read, stick around or if you’re on our mailing list, be on the lookout for an email with regard to a pain science education masterclass. It’s a 40-minute masterclass where Dr. Rothschild reviews a case study on a 45-year-old female with chronic pelvic and lower back pain.
This is appropriate for both physical medicine professionals as well as mental health professionals. Keep an eye out for a unique course offering that Carey’s delivering through the Integrated Pain Science Institute. It is called Pain Education for the Health Care Professional. This is a six-week, seven-hour CEU activity where you learn the latest in pain science, as well as pain education and how to effectively assess and treat the multi-dimensional nature of pain.
That’s a six-week course. It’s worth seven CEs/CEUs. It’s called Pain Education for the Healthcare Professional. Make sure you’re on the mailing list too. Go over to IntegrativePainScienceInstitute.com and hop on our mailing list. You can opt-in anywhere to receive our emails and you’ll receive updates both on the pain science education masterclass, as well as the Pain Education for the Healthcare Professional CEU course and activity. Without further ado, let’s begin and let’s meet Dr. Carey Rothschild.
Watch the episode here:
How To Create A Pain Education Course For Health Professionals With Carey E. Rothschild, PT, DPT, OCS, SCS, CSCS
Carey, welcome to the show. Great to have you here.
Thanks for having me.
You reached out to me about pain neuroscience education and pain science in general. You said, “I’m teaching a course on this and I’d love to come on and share what I’ve learned and some of the experience with your readers,” which we’re excited to hear about all the work that you’re doing. You’re a professor at a physical therapy program, a DPT program in Orlando, Florida. Tell us how you first became interested in pain science. Give us an idea of how long you’ve been teaching. When did pain science come into that picture?
I have been teaching in the DPT program at the University of Central Florida in Orlando since 2009. I pretty much first got interested in pain science, specifically, I knew the moment. I was at the APTA’s NEXT conference in the summer of 2016 and I heard Steven George do a talk, the John HP Maley Lecture and he talked about the roadmap to a pain revolution. That stuck with me and I left that conference thinking, “It’s 2016. I’ve been a PT since 1999. How have I never heard any of this before?” I thought it was quite fascinating and I knew I needed to come back to my program and figure out how I could learn more about pain science and how I could be an educator in pain science.
That was a great PT NEXT. I was there. I presented in that one. It was a fun PT NEXT. I’m sorry that they’re going away.
Me too. I did have a couple of posters that I was presenting there and I had never been to NEXT before. I typically go to CSM every year but haven’t been there to the NEXT conference.
We’ll have to start the next NEXT so to speak. It wasn’t a small conference. It was about 2,000 to 3,000 people. Those smaller events, oftentimes introduce you to things that you might not normally hear in a way that’s a little bit deeper and you get to connect with people in different ways. Often, we go to conferences or we come across maybe a book or a paper that takes us on a little fork in the road and you’re down the pain science route so to speak. What was your trajectory as far as learning about it? What motivated you to put it into the program? How did that all play out?
When I got back from the conference, shortly thereafter I found the Pain Reframed Podcast, which I’m not sure when it officially began but I know I started listening to it. I was already teaching the therapeutic modalities content in our curriculum. One or two of the modules had focused on inflammation, tissue healing and pain because that’s the context that modalities are often used in PT practice.
My first inkling was how can I expand what I’m teaching in this pain content. It went from 1 week of content to 2 weeks of content and trying to insert it a little bit more into some of the other courses that I was teaching like therapeutic exercise so it’s a natural progression. As I learned more, I thought, “Wow.” As I found the International Association for the Study of Pain Curricular Objectives, I figured, “If I’m going to be able to do anything with this, it’s going to have to be a free standalone course,” at least for our program. I didn’t see a way to naturally fit it into the coursework that was existing.
There are a lot of different questions about that with regard to pain science. Should it be a standalone course? Should it be embedded in another course? Should it be seeded throughout the entire PT curriculum? The DPT curriculum now is quite lengthy, over 100-something credits depending on the school you’re in, sometimes upwards of 130. What were those conversations with other staff at your university and the chairperson with regard to that decision? There are some people out there who do believe that, “These are concepts that should be embedded in that throughout the curriculum,” and other people who are like, “This is so specific and unique to what we’re doing as far as therapists that we need a separate course.”
I would say that I got pretty lucky. I did have great support from my program chair so that was a huge plus. It was probably Spring or Summer of 2017, where I was thinking, “We need to get this moving.” We are a public institution so things do take a little bit longer to go through the processes but I was at the time teaching two courses in therapeutic modalities. The first course was maybe more of the mechanical thermal agent type of course and the second one was all electrotherapy. I looked at the curriculum and content and I thought, “I could probably merge all these modalities into one course and have this room for all of this pain science stuff.”
My program director was completely on board and some of the guidelines for the NPTE exam had changed in terms of what type of content was being tested for modalities. In conjunction with having two courses, I said, “It makes sense to spend time teaching some of these modalities that aren’t even being tested now on the NPTE. Maybe we should go ahead, move forward and get in line with these, which we’re coming out within the 2018 objectives from the ISP.” It was a nice conversation that kept growing and getting more support. Everybody on my faculty was supportive and my program chair was huge because he said, “We’re going to figure out how we can change this second modalities course and make it a pain science course.”
Out with the old and in with the new so to speak. I can’t remember how many credits my modality course was in PT school. I feel like it was maybe 3 but 2 out of the program seems like a lot to me.
The total was five credits. It was maybe three for the first part and two for the electrotherapy. I still do teach a two-credit therapeutic modalities course and a two-credit pain science course.
The pain science course is two credits. It is a semester-long it sounds like.
It’s taught during the summer so it’s a truncated semester. It’s twelve weeks as opposed to the traditional sixteen weeks that would be typical of a fall or spring semester so we end up meeting for three hours a week because of that truncated time.
There’s a bit of a distinction between pain science and pain neuroscience education. There are some overlaps but some distinctions, too. Can you tell us about the distinctions between them? How do you approach that within the context of the course you’ve created?
The course is called Pain Mechanisms in Treatment and Rehabilitation so it definitely is a comprehensive look at pain from the basics of pain neurobiology and into how you best assess pain and inclusion of a lot of the outcome measures that have become popular. We go into talking about those individual differences and pain variability that you see in different patients in different populations. We talk about the mechanism-based approach to pain management for the PT and we do spend quite a bit of time talking about the therapeutic alliance and motivational interviewing. We do some roleplay with those two topics and we do talk about pain neuroscience education as an intervention or as an educational intervention.
They explain a pain type of modeling again as a mechanism for educational intervention. We get a neat time and we get to review some of the key concepts of the modalities course, which was taught the semester prior. We talk about some of the other interdisciplinary topics that are related to pain. They’re some things that you’ve highlighted on your show, sleep, hygiene and nutrition and lifestyle factors. We talked about some of the psychological approaches that are used in pain management as well.
They’re some of the things you’ve covered extensively on your podcast with regards to cognitive behavioral therapy, ACT and even basic relaxation, breathing and mindfulness-based stress reduction. They get all this at the beginning and the last two weeks and we talk about all those concepts in the context of some of the common pain syndromes like fibromyalgia, chronic headaches, chronic low back pain. Even moving into chronic regional pain syndrome and osteoarthritis, rheumatoid arthritis and those kinds of things. It’s definitely more, to get back to your question. It’s definitely quite a bit more than pain neuroscience education, which encompasses about 1 of the 10 modules that we have.
That’s interesting because you have a lot packed into twelve weeks. It’s about 36 hours and you’re covering a lot of different topics. I’ve looked at a lot of the research around pain education, cognitive-behavioral techniques and what it takes to train a practitioner in that. The bottom barrel limit is a weekend course, which is probably about fourteen hours but your course is going to 36 so you have some room to pack in other topics, which is great. I’m trying to think back to when I was a young sprite PT, which was quite a while ago. Is this their last summer before being seniors?
It’s right in the middle. It’s the beginning of their second year. We have a nine-semester program so this falls during the fourth semester of the program.
It’s pretty early.
It’s right before they go on their first clinical internship. I will tell you, as educators, we’re always tasked with, “How do you measure student learning?” I will say that our Director of Clinical Education states that a good majority of these students go on to do their clinical in service on something to do with pain science, something with pain neuroscience education whether it’s a ten-minute talk on sleep hygiene and they’re doing this to all the staff at the hospital or all the staff and outpatient clinic. That, to me, is exciting because I do feel like we have to be the army to get the information out there. That might be a room full of PTs, OTs or physicians, physician assistants and nurses so it’s exciting.
Is there anything you find that they latch on to? I don’t know how deep you are going into things like CBT, mindfulness, ACT, pain neuroscience education or anything specific that people are like, “Do I want to know more about X?”
They definitely latch on to that concept of therapeutic alliance and motivational interviewing so they want to get better at that piece. They can make that connection with the patient so they can make suggestions with regards to some of these psychosocial behavioral techniques that might be available. It’s interesting because part of my coursework entails using a great textbook by Kathleen Sluka and we also listen to podcasts. My students have enjoyed podcasts so we’ll have them listen to the Healing Pain Podcast or maybe the Pain Reframe Podcast and write reflection papers on the topic. It’s been interesting to read people’s topics.
There are a lot of students that have a tendency to enjoy mindfulness-based stress reduction and some of those techniques that maybe they’ve been exposed to before. I would say that they’re fascinated by a lot of it. When I was doing the lecture on graded motor imagery, they thought that was completely fascinating because they’ve maybe seen some of it. It was limited to rehabilitation status post stroke versus something that has maybe a chronic regional pain syndrome of the extremity.
I know many academics are interested in qualitative research. I’m wondering if anyone in the program has attempted to analyze any qualitative or even quantitative research with regard to the students coming through your course. You’re looking at their grades so you know if they’re passing or not but some of the more qualitative, what they found valuable, what they would like to hear more about. Should this be a two-part course like modalities? For some of these topics, you can spend a lot of time on them.
I would say this is something that I would aspire to do. The first time I delivered the course was summer of 2019 and I was trying to get myself organized and figure out what I was doing. I know that I was working week to week trying to produce something good. In the summer of 2020, instead of being able to deliver it face to face, I had to deliver online so I had a little derailment as far as my ability to do some research. That isn’t my plan for the summer of 2021. My plan is to collect some pre-data and maybe some post-data on some of the research looking at these effects or knowledge and attitudes about pain, using the HC pairs as an outcome measure or using the neurophysiology of pain questionnaire to do some baseline pre and post.
The neat thing that this is expanded onto is that our program is involved in interprofessional education events with our College of Medicine and our College of Nursing as well as pharmacy and some of our social work and counselor education programs. I’ve been able to take this to our own interprofessional events and the team of students works together to evaluate a patient who has chronic low back pain. It’s a simulated patient, a paid actor they get to meet and get a 30-minute presentation for me on pain science and the factors of things to think about when you do your exam. They get to go in as a team and interview this patient who is a simulated patient working from a script that I was able to write. I wrote the patient case. It has been neat to see the differences with other professions and how well versed they are in this area and this topic.
That’s great because I’m working with a group of licensed professional mental health counselors and they have wonderful counseling skills but they receive nothing with regard to pain science in their curriculum. They’re masters and trained professionals but that’s pretty consistent throughout all of the mental health professionals. At this point, PTs are leading the pack as far as having pain science in the curricula. It’s interesting, the interprofessional and collaborative opportunity that’s there for us as professionals to train other professionals in what we know and through that not only does it help them be better professionals and practitioners but it also helps them understand what we do.
That is one area that we’ve had. I was able to get some pre and post-data collection on that. We’re in the process of analyzing and stratifying based on the health profession in terms of pre-existing beliefs about pain. Did it change during the lecture component as well as the interaction with the simulated patient? We’re in a neat position to look at those things and we have to consider the year that the students are in their respective programs as well to see where they get it. As far as I know, we’re definitely leading the pack, at least at our institution. It’s hard in terms of the amount of pain education that our students receive.
The course you have almost sounds like an integrated pain course in a certain way. Are there questions that come up? For example, if you’re discussing healthy eating and nutrition, the questions that come up are, “Is this in my scope of practice? Can I work on nutrition during my clinical affiliation?” This is a question I get asked all the time. “When do I know I’m not being a psychologist or if I’m using ACT?” Which is a funny question. We never are holding ourselves out to be psychologists. We’re using principles of care to help inform practice. How do you approach those topics with regard to the students? I also imagine some of the faculty, when you probably brought this in, we’re not quite sure on how it fits into the curriculum either.
We always go back to our APTA as our governing body and our professional guidance for what’s within our scope. I often will reference, at least for the state of Florida, what’s within our practice act for the state, how those things are covered, how they are classified and if there is any vagueness to it. We also have a general health professionals practice act that we can follow as well so some of these things are covered under that and we’re allowed to do these things. I always tell my students that you can do what you feel comfortable doing and once you don’t feel comfortable doing it and you’ve gone outside of your level of comfort then that is definitely time to refer for sure.
Helping them identify their personal scope as they go out to the world. It’s interesting and I’m curious because it sounds like you have read some of the Florida scopes of practice acts. I have yet to see a PT practice act that limits us with regard to anything that we have talked about on this show, not nutrition, not psychosocial aspects, not exercise, etc. Do you find that to be the case?
I do and a lot of times when you see blanket statements that might be health and wellness or anything that’s designed for management of pain. All these things fall under that umbrella. The nice thing is my program director sits on the board of PT practice for the state of Florida so I know he had all of those things cross-checked before we embarked on the process to get it approved for the university. It’s been a neat experience.
Whenever I give a lecture on the nutrition act, that’s always the first thing. I used to put it to the end of the lecture and now I put it front and center because there are so many questions around it. What you’re saying is our practice acts include health and wellness promotion, all of them and this falls under it. I’m repeating this for our readers who are PTs. You don’t have to have your practice act spell out a Mediterranean diet or mindfulness so to speak. These are skills that if you didn’t maybe touch on them in school, like what you’re doing eloquently with your students, there are skills you can develop outside of the classroom so to speak.
Educating yourself, taking continuing education courses and pursuing extra certification as if that is an avenue that you feel you need more skillset in and that you want to be better at in terms of being able to deliver that type of intervention for your patient.
You don’t have to use nutrition or mindfulness but if you choose that’s something that you want to implement, you can go for further training on that and use it. How would you like to see your course develop as you go through and teach? Beyond your third cohort which is coming up, you’ve had carte blanche and you can do anything with it. What do you do as far as credit hours, techniques and methods within the course?
I’d like to bring in possibly some more guest speakers that are knowledgeable on some of the information that I don’t have a strong skillset in. I would love to bring somebody in that’s an expert and can teach mindfulness-based stress reduction or to teach CBT or ACT. That would be a neat addition. I’d like to do some more role-playing. It’s one thing to have students play roles with other students but I always have my students think about if they know somebody that has persistent pain.
Play that role whether it’s your grandmother, your neighbor or your aunt. Play that person for your classmate to evaluate. That usually works but it’s been a neat experience to have a simulated patient as well to work on those soft skills with the interviewing piece, the motivational interviewing and the therapeutic alliance. I would love to have some more experience for the students and some more situations where they can articulate the pain neuroscience education piece. That is a skillset that you have to rehearse to some degree that doesn’t come easy to a lot of people.
Have you had input or anyone reaching out from other universities saying, “I heard you created a pain science course. What does it look like?”
I haven’t. I was interviewed with our university newspaper about this course. I looked to see how many universities in Florida have a standalone pain education course, to that matter. I honestly couldn’t find anything with any of the curriculums that were available to the public. That doesn’t mean they don’t exist but I do feel excited that I was able to get this underway and I would love to help others start something like this. I do like the standalone model. I know that doesn’t work with every curriculum, I found myself in a nice position to be out with the old, in with the new on this particular course. I would love to do some more collaboration in terms of launching courses and also figuring out how we can get the best quantitative review of how the students are doing in this type of coursework.
I’ve done some poking around in the state of New York, we have a lot of PT programs here. I found some surveys of the curriculum, talking to both the directors as well as looking at the websites and I have to say what you’ve done is pretty unique. It doesn’t stand out. You can go on to a university website and try to look at a curriculum. Hopefully, it’s updated but they don’t stand out in the way you have created. Do you think that’s a function of CAPTE? Should CAPTE be more specific and provide a little bit more direction? Do you think there’s naturally some flexibility and fluidity in a program and it depends on the program itself?
It’s something that the CAPTE probably will be addressing. Accreditation is good for ten years. That’s a huge gap. Our program went through CAPTE certification 2013 but we’re not due until 2023 so it’s coming. Since the APTA in 2018 did endorse the International Association for the Study of Pain curriculum outlines for DBT education, I would think that it’s probably coming to that point. Ironically, CSM has a live presentation looking at implementing, recommended core competencies into physical therapeutic education specifically for pain education. There’s a nice panel of people that will be speaking at CSM so I’m looking forward to that. I feel there is going to be some interesting discussion on standalone courses versus integration through the curriculum and what may work for one university may not work for another and that’s fine. I’m glad I could share how it’s worked for our institution anyway in Orlando.
On some levels, I almost feel that what’s happening in consumer education and what’s happening in the clinic is out-passing what’s happening in the curricula at times, not yours. Your course is forward-thinking but I would imagine in some schools and I know this because I trained therapists myself, they’re saying, “I didn’t receive a hint of any of this.”
I hope that my students are the army that goes out there and shares this level of knowledge. There was an article on JOSPT and the lead author was Adriaan Louw. I know you’ve had him on your show. He was talking about not the need to educate the student but the need to educate the clinician. Hopefully, if we educate our students, they go into clinical. They can educate maybe their clinical instructors who maybe have been out of education for a while, at least to give them a little snippet of it and maybe that’s the spark that gets them to go take a continuing education course or go learn more about it. That’s my hope.
Mine too. We have a large profession now. We’ve now grown in the number of PT schools and with that the number of professionals that are practicing. There’s probably a whole section of people that are invested in their professional development. There are people who are doing the bare minimum and they’re saying, “I’m going to take a two-hour continuing education course.” They are probably sitting there with a beer in their hand as the video is playing. For us to maintain being primary care providers of pain, both acute as well as chronic, courses like this are needed both inside the curricula as well as outside. I appreciate you putting that together. Carey, it’s been great chatting with you. Tell us how people can learn more about you and what you have planned for the future.
I’m not big on social media but you can find me at the University of Central Florida. Type me in as a faculty. My email addresses Carey.Rothschild@UCF.edu. That’s probably the best way to get in touch with me. I do have some plans to hopefully get some research out there with regards to the study that we did collecting some pre and post-data on our interprofessional event. I also have some students that are looking at doing a summary of pain neuroscience education, different methods of delivery and whether it’s better online or in person. Especially with the world of telehealth, trying to look at how we can maybe implement some of these things in a virtual format.
You can reach her at the University of Central Florida. Her email is Carey.Rothschild@UCF.edu. You can Google her at the university there or you can find her on our web page. Carey mentioned she’s not big on social media but she will be big once you all share this information with your friends and family. Make sure to share this with your friends and family on Facebook, LinkedIn, Twitter or Facebook groups of people talking about pain science and pain neuroscience education or other types of interventions with regard to the safe and effective treatment of chronic pain. I want to thank you for joining us. We’ll see you next time.
- Pain Reframed Podcast
- Adriaan Louw – Past Episode
- University of Central Florida
About Carey E. Rothschild
Carey E. Rothschild, PT, DPT, OCS, SCS, CSCS is an Assistant Clinical Professor in the Doctor of Physical Therapy Program at the University of Central Florida. Dr. Rothschild earned a Bachelor of Health Science in Physical Therapy in 1999 from the University of Florida and a Doctor of Physical Therapy from Boston University in 2005. She became board-certified in Orthopaedic Physical Therapy in 2006 (recertified 2016) and in Sports Physical Therapy in 2012. She completed the coursework in pelvic physical therapy and earned a Certificate of Achievement in Pelvic Physical Therapy in 2020.
Her 20 years of clinical practice has been in the areas of orthopedics and sports medicine. Her research interests include management of running injuries, conditions of the female athlete, and pain neuroscience education. Dr. Rothschild is an avid runner, swimmer, and triathlete having completed numerous races including the Boston Marathon. She is a busy mom of three elementary school-aged children, 2 girls and a boy.
Love the show? Subscribe, rate, review, and share!
Join the Healing Pain Podcast Community today: