Audio of Pain Practice OS Pod

Mark Kargela: [00:00:00] What's going on everybody? I wanted to take some time this week. It's been a little bit since I've been on the podcast, and I apologize. I try to be a weekly publisher, but it's grown to become hard, and when I first started this podcast journey, I had no idea where it would take me. Definitely didn't think I'd get into 180 episodes.

I think you hear that it's 10 episodes or more. Most podcasts rarely make it to 10 episodes. So proud of that. But why haven't I been published in the last couple weeks? Well. I've been working on something that's like a passion project, something that, a little backdrop.

I'm one person who's very fearful of public failure, right? I've had a few episodes where I launched things and they didn't go well. Various things in my life where I had a private practice. I tried to start 11 years ago and that failed. Ended up having to give up that thought and well was a learning process, right.

But as I've gone on in the career and been able to start modern pain care, gosh, now, eight or nine years ago, [00:01:00] and I've had various programs and different things go on, decided that I really felt like I still wasn't really doing as good as we could to really meet the need that's out there. I think having the opportunity to have this podcast and talk to a much amazing guests.

Patients who've dealt with pain and come out the other side and clinicians on the front line. I think it's been really made it apparent that we have a massive need out there that isn't being met. And that need, I don't think is a surprise to any of you.

There is not good pain programming out there for people in pain who aren't fitting the, I'm gonna identify something and fix it. Be it a medicine, an injection, a manipulation, a dry needle or whatever. So, and everybody has these people in their practice. I know I did. And still have patients where they don't respond to things that, a manipulation or a needle, or maybe they do temporarily, but it doesn't get them back to their life.

Right. [00:02:00] And biopsychosocial has been a big push over the last 10 to 15 years. I still think we give it lip service, right? We sometimes, ooh, I have my, now my, my spro or my or bro that I throw out there at somebody. So I identify 'em, I can tell this person's got yellow flags or psychosocial issues.

And then you might give this little pep talk about PNE and all these different things. But then I still see clinicians, for the most part, they go back to regularly scheduled programming and go back to traditional ways of doing it. I think it's one thing to, to identify and it's another thing to do something about it, and I think psychologically informed care.

Right now still we get it at a surface level. We don't learn it in university where we have really any significant psychologically informed skills besides identification. We don't have currently anyone, well, there's some folks teaching skills, but in a package that allows you to deliver something of meaning to an individual or a group.

So that really has been my stimulus. One I'm, I've been delivering pain programming to individuals for the last [00:03:00] five years or so now. Really have been ramping it up over the last few years when I've been fortunate enough to have Brownie Thompson guide me and mentor me in my application. My understanding of act 'cause act is a big part of how I apply, pain management strategies for folks that are, still living on the sidelines of life, waiting for pain to be fixed and helping them maybe say, let's get you off the sidelines.

And sometimes that's your best treatment is to get back to life and help, manage your pain that way. And it's been a massive. Improvement in my ability to help those people. But it's such a massive improvement in my fulfillment in my practice. I mean, this hopefully doesn't cross egotistical, but I almost get sick of the regular oh, this is your average back pain.

This is your average shoulder pain and different things that, a good portion time, they're gonna get better. And I feel like, yeah, I probably help it by my interaction style and different things. I no longer think I'm the hero of the show. I can help patients. Navigate that, and I feel pretty confident that I can get a lot of those things better.

Of course, there's people that still don't get it, better they have conditions that aren't gonna get better with [00:04:00] conservative care or various things. What really drove my passions are the people that wouldn't respond to that stuff and didn't get better and would feel better in treatment, but then wouldn't carry over in life.

And then I realized, well, we need to figure out what's going on in their life and start asking some difficult questions and having skills to truly do psychologically informed care. 'cause I've gone through it in surface levels. I did a TPS certification through evidence motion. It was great, but it was surface level.

I, I had two meetings in person with. Adrian Low's group, which are amazing people. I love Adrian. He's a great person. But it was like this disjointed learning experience where I did online stuff. I might have posted a little bit online, but I wasn't really getting taught while I'm applying it.

Right. And I felt like it, I had tools, but there was a really wasn't a coaching or mentoring thing. As I'm having the struggles with individual cases, can I bounce ideas off of? There was a little bit of it, but I really just feel like. Our current mode of continuing education is so dated of like weekend courses, even our certifications where you take online courses and then you might meet for some labs and do different [00:05:00] things.

And I'm just, I'm not saying hybrid models are bad, but, and I think you can do virtual things where there's some coaching and mentoring and guidance that you can do virtually that you couldn't do before. So I think more and more people have access to coaching and mentorship than ever before. I don't think.

We're in a situation where we need a clinician staring over your shoulders as you're wiggling a millimeter of facet glide and, oh, well, you're not doing that immediately directed or it's not appropriately, I'm not saying there isn't an appropriate skill with hands but that's been kind of played out a bit.

I, I argue that a lot of, that you can learn on the, go with clinicians, everyday clinicians and, get some mentors locally, but, the true mentoring and coaching is like, how do I actually do versus identify psychosocial care, right? I can identify the need for it, but I can't provide it, which I think our society is so devoid of pain programs, like pain psychologists are far and few between.

I love them, would love to, to multiply 'em by the thousands, but it's just not the way it is. And our, it's time for us to get sick [00:06:00] of waiting for someone else to step up and fill the need that's out there in our community. So to me, it's step up or step aside. We need to be able to step up and be able to meet the needs our communities have.

We need to be able to provide pain programming. It requires us to learn new skills, motivational interviewing, guided discovery skills, graded exposure skills, acceptance and commitment, therapy skills. Being able to, respond to difficult emotions and thoughts and feelings and. Just difficult stories that enter our room and be able to lean into 'em versus what I used to do, lean away and run when people would cry or get angry.

I tried to run the other way and try to change the topic or do whatever, but the skill to lean into those difficult emotions and help somebody make sense of 'em, and especially make sense of them in relation to their pain. So with all that said. I have some big goals. I have some things that I want to accomplish as a therapist.

I love my job. I am fortunate to work at university. I mentor students. I'm privileged to, be able to do some great things, but [00:07:00] I also feel like I have so much more I can offer and have a global impact on pain. And I know that sounds very grandiose. You're gonna have a global impact, mark.

Well, I think we have the opportunity to do that with our unique abilities to connect digitally to leverage AI to do different things that I think we are, and to get our message in front of people on YouTube and other mediums that require no. Intermediary. We don't have to, and it's free. You can put your stuff out there and like people, advertisers would like drool to get their information out in front of people.

In radio days and in tv. Advertisement days Now we can get our information out there for free. You have to understand the algorithms, which we are helping clinicians understand of how to create content that is gonna fit the interest based algorithm that we live in today, and TikTok and YouTube and all these things.

Well, we have an opportunity to gather, to gain the attention of people who we have a solution to their problem in the form of this pain program. [00:08:00] We don't need million dollar ad campaigns to do this. We can do this with our content and with our ability to share stories with the people we serve who've made a brave journey to change their lives around pain and turn their lives around.

I've been fortunate to interview people in their podcasts who've done so. And they're the best advertisers out there for this type of care. 'cause they've done it, they've been there, they've walked into the shoes that these people have walked in. And are the best people to, to show them that there is another way to, to navigate it, navigate life.

So with all that said, I, my dream is to have pain programs. And my goal in the next year, maybe two years, maybe I'm being ambitious, is to train a hundred clinicians that are starting pain programs in their community, be it individuals, be it groups. I don't care. That you are providing sound, psychologically informed care within scope, because I know there's that fair criticism of and we explicitly give [00:09:00] people some good understandings of how to stay within scope in our, in your work.

But we want a hundred clinicians trained worldwide, I don't care. Us Zimbabwe and everything in between. I don't care where it is 'cause people just need help. Our communities are in dire need and we need to step up or step aside as I mentioned. So. We are providing a program that will give an eight week relatively scripted program.

Obviously there's not, it's not like you're reading a script, but it gives you a layout of how to deliver psychologically informed care, be it an act based model. There's also some pain, neuroscience, education, obviously me, motivational interviewing, guided discovery principles, all sorts of things that allow you as a clinician.

Could be a pt, could be a chiropractor, could be any person who's qualified to manage pain in a pain program and the deliver a program that changes lives. That's all I would like is just for us to change lives and to deliver care that gives the opportunity. [00:10:00] Now any pain program's gonna have attrition.

We know that there's just people that might enroll and they're just not the time and place. We all have them in our clinic right now who you think we got an opportunity to help, and they're just not in a place to make that change. And maybe they roll back to us down the line when they are further along in their journey and maybe able to look at this type of approach.

But. With that said, the one thing I've recognized with my failures in private practice is to develop a program. A couple things. You need to be, one, you need to have a fi, an ethically financially sound model of care, and be it whatever system you're in, whatever country you operate in, whatever the barriers are, you need to find a way to deliver this care in a financially viable mode.

Now. I know a lot of people get uncomfortable the moment we speak of money, and I get it, but truly I have come to the conclusion through getting mentored and myself, I don't wanna say reprimanded, but dude, you need to get over it. Of, we have a duty to charge and make a financially viable program if we want to grow and scale [00:11:00] and have the impact we want.

'cause guess what? If you can't pay the bills and keep the lights on, your pain program helps nobody, it won't, it will not affect anybody. Now, does it need to be something that maximizes and like fleeces money outta people? No, but I also think how much would you pay to get your life back? And I'm not saying we need to exploit that, but we also need to be willing to leverage our expertise and understand that it is worth monetary exchange of value.

That is what sales is you have something of value that the other person values that they will pay money for. If you look at late night TV or some of the ridiculous infomercials of what people are shelling over thousands, I've had patients shelling hundreds of thousands of dollars to ridiculous knick-knack crud that gets sold to them of people who are preying on them.

I think we can ethically with good conscience is with good research and with good support from patients who've been through a program that's helped them tear on their lives, charge a reasonable rate that allows you to be financially viable. If that makes you uncomfortable, then maybe you roll out a financial [00:12:00] program that's pro bono.

If you can do it, then more power to you. I cannot my system is not hugely and, revenue generated at university, but I also work in, have worked in systems where you're not gonna be able to put a program together if it doesn't financially make sense for the business owner, the employer. We need to be able to provide that.

So that's something, I think that's a huge thing that clinicians lack some of just the financial literacy of what it means to do that. And I think providing clinicians with financial calculators and things to determine what models are part of their would be best for them in their system and in their unique setting is part of what we wanna deliver to people.

The other thing I think clinicians, and I know this clinician struggled my, this when I failed in private practice, it was because. I thought that I have, I was a fellow of manual physical therapy at the time. That was enough. Like I felt like I had arrived. Like where's my coronation? I am now here to change the world.

And guess what? One of the more ego bruising things in my life was to realize there were grad new [00:13:00] grads, one to two years old, absolutely kicking my ass in private practice because guess what? They knew how to market and they knew how to story tell with a purpose, which is what marketing is, right?

It's a purpose of under showing your ideal be it a physician. Be it a referral source, be it whoever it is, be it, maybe it's a chiropractor in your community that doesn't do this, that you want to kind of establish a relationship to show that hey, the patients that might not be responding to this, that, hey, I think I can maybe help and maybe I can help you out and, establish maybe a mutually beneficial relationship.

But being able to market is something that, 'cause I don't care how many letters, how many certifications you go through, how many fellowships you go through. It means diddly poo squat. If you can't. Get anybody in your program, nobody. If nobody wants to get in your program, nobody enrolls in your program.

It does not matter how amazing the content is. It could be citationed from thousands of citations. It doesn't matter if you don't have skills [00:14:00] to market and to be able to get your message and get your messaging right. And as far as cutting through the fluff, ethically, showing that I have, you have a solution that can help a person who's in a difficult situation.

Part of what we're trying to do and what we're doing in our program is to give people those resources. What are some social media posts and content? How do you use AI to kinda write in your voice and to develop marketing materials? That will resonate with your ideal audience, with their unique problems and your unique culture.

And your unique town, your unique ethnic background, whatever it may be, that you can, the, we have a, we live in a unique time where you can really tailor a marketing message. Of course, we want it not to do just AI generated. It needs to be some personal, legit, from your heart, passion stuff coming out of there.

'cause that's what people resonate with. So providing. People with webinars they can present to their community to help people see maybe a different approach to pain might be worth it for [00:15:00] them. Providing them with marketing, with social media posts, scripts, and ways to develop those through AI generated help.

Able to provide brochures, white papers for you provide to physicians. These are all things that I thought, well, what are the things I think I wish I had that if I was gonna go launch this in the community by myself, I'll be launching a group program in my own practice. That'll be part of the community as well as you see me succeed and have my own struggles as I deal with some of my unique challenges in my setting.

But. What are the things that I feel like people need to be able to deliver this and to market it well, and part of it means you have to come outta your comfort zone a little bit. It doesn't necessarily mean you have to do video based things. Some of it could be if you're not somebody who's comfortable on camera, maybe you're somebody who's doing some things more written word or via posts or different things.

But there's also assistance you can use like teleprompters. There's cheap health teleprompters. We will definitely help you get in touch with the tech you need. The skills you need to get comfortable if that's something you think you need to do to get your pain program off there. But you have to be able to put your message in front of a person so [00:16:00] they know you enough to have know, and trust you enough to say, Hey, this is a person I'm gonna spend some money with.

Guess what? That usually takes anywhere from 10 to 11 touch points. A person. So you need to have a strategy. Now, sometimes you also can use different strategies like community outreach strategies. Maybe you go to some local health fairs and different things and have conversations with people right there on in health fairs, maybe you have physician relationships where you do some more traditional physician marketing where we give you some white papers and some supportive PowerPoint scripts or whatever you want, that allows you to go in front of a physician and show that you have a solution to the problem they have. 'cause they often have these people in their practice and they're struggling to manage them.

And they're often under a crunch for time and physicians. I wouldn't want to be physicians in a lot of cases in certain settings where they're crunched for time and getting squeezed, and to provide this human based listening, validating care just isn't sometimes an unfortunate, unfortunately, it's not an option for them at all times.

So being able to market this is huge. So how do we change this one? You can definitely, I think anybody right now [00:17:00] has the capacity to take a course. I mean, Joe Tata does some great stuff. There's ICE has a persistent pain course. And all those things are fine, but I think. Where I think we, I've recognized there's a huge shortcoming is, well, how do we get someone to have a launchable program that they enroll patients in?

Not just, here's how you'd perform this care. Now I don't know how you're gonna do it. Build a program or thing. So we wanted to give people a structure. A framework to roll this thing out, to be able to say, Hey, here's my marketing. I got some people coming in the program. I have a regular pipeline of people that are coming in you.

You develop some word of mouth strategies, some regular marketing activities, some regular email things. We're gonna provide people with email sequences and the ability to provide nurture sequences for email marketing and different things like that provided. That's an option. Some health systems, of course, that may not be able to be done, but we'll figure out what it is for your health system and help you kind of navigate the best way you can within your health system.

So again, he, you, with the whole Continu education currently has on helping people [00:18:00] really, truly launch programs, it's not gonna happen in a two day course. I don't care what, how amazing that two day course is. I could not teach this in two days and have you successfully launch in a pain program. That's why at eight-week live cohort courses, how we're looking to deliver you.

And at the end of it. Start looking at and, developing this program and launching it and getting support as you're doing it as you're bumping into problems, you come back to your community. You'd let the coaches, the mentors and your peers in the community that are doing the same thing, trying to launch the same program.

You, you problem solve. We group think we put our heads together and we push each other forward, right? So we can help these programs start to launch across the country, across the world. We have clinicians outside the US definitely interested, that'll ideally be. Enrolling this as well, and you'll get coaching and mentoring.

Each week will be accompanied with live sessions where instead of you getting this, you're done at the last slide on Sunday con ed course, you get your last slide. You can digest the material. You're gonna have some [00:19:00] experiential activities where you actually have to apply it instead of just do a boring quiz and, oh, I know it now because I passed an A, BCUD or E quiz.

It's not how you're gonna learn, it's not how you're gonna learn. Well, at least. So you'll have weekly meetings where, Bronny, myself Ben Whybrow is gonna help us as well. He is our community manager who's gonna make sure the community's provided massive value for the folks that are in there who are gonna help you navigate your struggles.

And as you're learning how to do act and present moment awareness and mindfulness activities. And what does it mean to help somebody work on acceptance skills? What does it mean to have somebody be understanding their self as context, not self as content various other things that we will, we get deep into.

So you're proficient in understanding act and to start applying it. Are you gonna be proficient and skilled? No. When you get done with eight weeks, no. But you're gonna be proficient as skilled. The more you do it, the more you get feedback and the more you get supervision on what you're doing with patients.

We're gonna have some AI assistance to help you understand the fidelity of your interventions to see how well you're doing motivational [00:20:00] interviewing. While you're doing acceptance and commitment therapy, because talking about it and saying you can do it versus doing it and getting some feedback on it can be two different things.

So there's that. I also am uniquely positioned where I have the video tech, not in this room, but I well in this room, but I'm not gonna be having patients coming into my home. But I have the ability to film. I have tripods, live streaming devices and equipment lighting. The whole nine to go into a space and film real patient scenarios.

One thing I've respected massively over Peter O'Sullivan, McKenzie Institute and others, is they treat real patients. It's not this fluff of like folks in academic ivory towers saying, this is what we should do, because the clinical practice guideline that. So I'm not saying those aren't important, but if you're not in the clinic, I have a hard time.

Getting hugely bought into what you think, 'cause you're not doing it, you're not on the front lines, blood, sweat, and tears navigating these difficult conversations each day you can say, this is what you think it should be. And maybe there's some legitimacy in some of the things, but I have a hard time for folks that aren't [00:21:00] doing it or haven't done it.

I mean, maybe they've done it and they've switched, but that's another maybe podcast discussion. As you can see, it gets me frustrated. But yeah, you need to have. Folks that are doing it and understand it and can kind of give you feedback real time with what you're doing and how to grow and learn and to get the supervision to develop these skills again, proficiency.

You'll be at a basic level coming out just like you're in school. And then as you start getting reps and getting feedback in our community. And we would love to, to be the folks you stick around with and have the community here where we have some experts that can coach and guide you and really get you in a good spot.

But obviously there's mentors in your community stuff we can definitely help you connect with folks we know that are around you too, that can help you grow. So that the course, like I said, is a eight week cohort course. And I'm telling you stuff I want you to kind of hear, 'cause I'm gonna come back in and check in with you on the podcast and let you know, well, here's how it went.

This launch is coming up in a couple weeks and it may go swimmingly. Well, it may go like crickets. I don't know. I've been trying to tease it. I'm not. By any means an expert marketer, but [00:22:00] I wanna share the journey with you a little bit. I wanna share the content of what we're doing in this community, of the con, the conversations we're having, of the lives we're changing, and all that stuff.

Front and center of the contact deals. Content you're gonna see from Modern pain care, be it the podcast, be it reels on social media, video content, shorts, all that stuff. Mainly just to get the awareness out that we need these programs to start growing and expanding around the world. And I'm tired of waiting for other people to do it.

I just don't think. We yet are, just taking people and teaching 'em act or teaching 'em mi on an island is not, to me what's at least helped me. I need someone to put it in context and help me develop a program and a structure to start doing it, not just talking about it. So that's what the program's all about.

We're gonna have a community component that also, beyond the course, we'll have experts and experts that. One mistake I've made in the communities in the past that I've ran that have failed, I shouldn't say well failed I guess, 'cause they're no longer in existence. So, is I'd go a mile wide and about an inch deep where I'd have experts from anything from [00:23:00] ACL to return to sports, to pots, to long COVID, to all these different topics and techniques.

And I then, never really going deep in anything. This community's job is to go deep into how do you apply psychologically informed care for, initially it's gonna be around a persistent pain population, but it will eventually start scaling to, how do you recognize this in an acute patient, a pediatric, a geriatric, an athlete?

'cause all these people, guess what? They have thoughts, feelings, and beliefs around what they're dealing with. And those people will also have yellow flags that show up in their world and in their life around their injury or pain situation or illness. That might predispose them regardless of this artificial three month barrier of chronic pain that we've supposedly identified that might signify that, hey, if we don't intervene here with something besides just screening and identifying it, that's one thing.

Again, can you do something about it? Those are the skills we need to develop as clinicians and that we're gonna help people engage with and do in their own practice. So. That's where we're at. My goal, as I [00:24:00] mentioned, a hundred clinicians across the world trained in this and delivering the care. We want to create a directory at modern pain care of clinicians who've been trained in this, that when we create patient facing content, which is the plan, as we start scaling and getting cohorts going through of where we can start creating patient facing content that is gonna get the message in front of these people, that whether they live in Luxembourg or Norway or the US or Australia.

That I can say, Hey, I can't treat you there legally. It depends on how we structure the programs too. 'cause there's ways to structure this where it doesn't necessarily have to be an insurance based. It could be something that's structured as a wellness program, and that all depends on legalities in your area.

So, and that's something too that we make sure we help people understand the making sure things are falling in within the law and policies and procedures of your local jurisdictions. And making sure you have contacts with lawyers and things to make sure you're doing it all by the book and within the law.

But there's, I want to have the ability to take, to [00:25:00] put messages out there and know that I have a bunch of clinicians out there who I would trust with my mother to see for these issues. And I can send these people on and we can start expanding our network of clinicians that now, man we are across the globe and we have clinicians that are making a massive impact on their communities.

A, a ripple effect that I think can make a big dent in pain care. 'Cause again, I'm sick. Of waiting for some sort of public thing. I'm not trusting our government in the US to get much done. Anytime any of you watch the clown show, that is our government. I apologize if that offends anybody, but.

I just get frustrated it's year after year, regardless of which side's in power, where it's just this mud throwing contest of nothing getting done, rarely. So, it's time we step up and not wait for this stuff. And I think the more we put this at a grassroots, let's get people, let's put our message in front of people, not worry for, wait for, obviously stay by the law of our lands and our governments, but also not wait for them to change policy and things where let's make changes that push policy change from the grassroots up.

I think we have an opportunity to make a big impact on things. So. [00:26:00] As I mentioned, I'll be checking back in with you. I'll let you know how this thing goes again, maybe it doesn't go well and I'll reflect on how poorly it was marketed, or maybe I marketed it. Great, and we fill our cohort. We're gonna initially have a cap of 30 people, just because I wanna make sure we have the ability to focus on the people in front of us and not dilute our attention to where people are gonna get the individualized attention they need.

If you're interested, I'd be honored if you joined me to start this movement. I think it's something that is sorely in need. Of course, I'm passionate about it. I'd love for you to join me if you want and you're interested in maybe hanging out with us. Jump on modern pain care.com/pain program and you can jump on the waiting list.

You'll get opportunities to get some early bird bonuses where you'll get like a one-on-one call with myself so we can set up your situation and tailor all of this learning specifically to your unique situation. So hopefully it's of interest to you. Maybe it isn't of interest to you, somebody who would benefit of it, or you or somebody who might be interested.

Pass this on. We'd love for them to hear it. If at all, hopefully this maybe gave a bug in your butt to, [00:27:00] to start learning how to market, learn how to financially be literate with what's going on, and how to start creating programs, whether it be through our program or maybe you have some act. Or some mi stuff that you've learned in the past, but start learning how to sell it and to fill it with sound marketing strategies, sound financial strategies that allow it to scale or grow.

I, I will support you a whole hundred percent if, and I'd love to have you on the podcast if you're making a impact in your community with a pain program right now. Message me. Let's get you on the podcast and share it and celebrate it and help inspire others to do the same in their community. I'm gonna leave it there this week.

Like I said, drop a comment. If you have any interest,

until next time, we'll talk to you next week.

Announcer: 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 [00:28:00] needs, changing the story around pain. This is the Modern Pain Podcast.