A Recipe for Healing: A Clinician’s Review of Rachel Zoffness, PhD’s New Book
In this chronic pain book review, Dr. Kristen MacKenzie explores how Rachel Zoffness translates pain psychology into practical tools for patients and clinicians.
Review by Kristen MacKenzie, MD, Book by Rachel Zoffness, PhD
“I finished this book on the airplane back from our annual American Academy of Pain Medicine meeting, and it was chicken soup for my soul. Our annual PainConnect conference highlighted how far our field has come, from surviving the opioid epidemic to developing multidisciplinary models. We are constantly striving to bring the best care to our patients. However, there are still turbulent waters ahead. We are seeing challenges to quality care with our core interventional procedures under scrutiny, ongoing funding barriers for quality research, and a lack of reimbursement for psychological services. Multidisciplinary care that embraces the bio-psycho-social model allows our patients to thrive and heal, but what is an accessible, practical introduction for patients?
Enter Rachel Zoffness, PhD, a pain psychologist and thought-leader revolutionizing the way we understand and treat pain. She is an assistant clinical professor at the UCSF School of Medicine and has helped countless people understand and heal from their chronic pain. This book is divided into three parts, and, much like a cookbook, it lays out a comprehensive, customizable recipe for how psychology can meaningfully improve chronic pain. The best part is that she explores these concepts in a non-judgmental space, using anecdotes from patients that she has successfully treated.
In the first part, Dr. Zoffness explores the foundational science of pain- emphasizing that pain is both a sensory and emotional experience, both of which definitionally require the brain’s participation. She argues that – while pain is traditionally thought of as a discrete event that resolves when tissue damage heals – a large proportion of chronic pain is “idiopathic” and may not respond to the conventional therapies that we know work for acute pain. For instance, our stress system is designed to respond to immediate, short-term threats. With modern society filled with constant push notifications and a news cycle in hyperdrive, we have easy access to stressors that hi-jack our evolutionary nervous system, leaving us in a constant state of hyperarousal.
Now that we know the ingredients of pain, Dr. Zoffness launches us into the second part of the cookbook. Much like cooking a recipe at altitude versus sea level, there are multiple factors beyond the simple “ingredients” that contribute to pain. She examines how socioeconomic status, gender and sex, early childhood experiences, and trauma shape the way we perceive pain. The concept of placebo and nocebo is also explored- the fact that if we expect an intervention to work, our brain will release powerful hormones to create real, lasting pain relief. This, she says, is self-healing, and I couldn’t agree more.
In the third and final section, she teaches us how to make our own recipes for chronic pain relief. Useful to both patients and providers, she invites us to select from a menu of personal triggers to customize our own plan for self-healing. For some patients, their “High Pain Menu” may include the belief that they have incurable tissue damage or inherent muscle tension that cannot be resolved. On the psychological side, there may be emotional suppression, high stress, and unhealthy coping such as drinking, isolating, or avoiding. She also encourages patients to identify these aspects in their own life and do an “ingredient swap” – selecting items off the “Low Pain Menu” instead. For instance, if the patient notes that having poor sleep makes their pain significantly worse, she offers tried and true strategies for optimizing a night’s rest.
If you are one of the members of our society struggling to find a pain psychologist in network or lacking sufficient time to address the bio-psycho-social model with patients, this book is an opportunity. It is a cost-effective way of not only educating patients but also empowering them with strategies to start making changes on their own. And that is some self-healing chicken soup.”
About the Author: Dr. Rachel Zoffness is a pain psychologist and thought-leader revolutionizing the way we understand and treat pain. She’s an assistant clinical professor at the UCSF School of Medicine, lectures at Stanford, and consults on the development of pain management programs around the world. She was trained at Brown University, Columbia University, UCSD, Rockefeller University, Rady Children’s Hospital, and Mt. Sinai Hospital, and is a Mayday Fellow. Dr. Zoffness has served on the boards of the U.S. Association for the Study of Pain, the Society of Pediatric Pain Medicine, and the American Association of Pain Psychology. Her new book, Tell Me Where It Hurts, is out now and will be translated into more than 25 languages.
Kristen MacKenzie, MD
AAPM Media & PR Committee, Women in Pain Medicine SIG Chair; Clinical Assistant Professor in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford