Why Do I Hurt? Workbook. Adriaan Louw. OPTP Publisher. 2016, soft cover, 35 pages, $5.95 each or 12 for $54.40.
Many physical therapists know the work of Dr Adriaan Louw in neuroscience education. His series of books on pain education are written for patients and are simple and clear for patients of many diagnoses. I have been using his book Why Do I Hurt? with patients who have chronic pelvic pain for several years. The analogies are easy to understand and hit home for most patients. The new addition to the series is a workbook for patients to engage in the process of tracking and recording through active participation. It could be used by the patient alone but would be more effective when used in conjunction with individual physical therapy (PT) sessions or even a series of classes lead by a physical therapist.
The workbook has 8 chapters starting with the patient's pain story and a validation of his or her struggle. This tends to get the patient's attention and helps him or her know that the therapist understands his or her struggle. An explanation of the nervous system, how it can become sensitive, and the symptoms of a sensitive nervous system follows. Psychosocial influence in pain is also discussed in a simple, easy-to-hear way. The text invites participants to write down the symptoms they have and the surrounding factor that influence their pain. Chapter 4 also points out that many conditions that can be measured (ie, a disc bulge) are not necessarily associated with pain.
The text continues with information about how pain can influence other areas such as memory and motivation, "the pain meeting" and the stress response and pain, "the lion." Each chapter is 2 to 4 pages long and has pictures and spaces for the patient to insert his or her experience and individual situation. The treatment chapter is the longest at 8 pages and describes the 4 pillars of treatment: understand pain, aerobic exercise, sleep, and goals. Throughout the workbook, gradual increase of activity at the correct intensity is encouraged. Participants are encouraged to write down their goals, and the workbook includes a page to fill in one's own exercise plan. The overall goal of treatment is to turn on the endorphin release in the brain, and this is also encouraged by alternative treatments such as sleep hygiene, medication, breathing, massage, and more.
The text includes 33 references from the past 10 years and all levels of evidence. This book, like all of Dr Louw's tests, is based on good science, well written, and an asset to PT treatment. Therapists are encouraged to learn more about neuroscience education by reading the cited references. This workbook allows the physical therapist to easily integrate pain neuroscience education into everyday practice. I recommend it as an easy and inexpensive tool to include in the treatment of chronic pelvic pain.
Beth Shelly, PT, DPT, WCS, BCB PMD
Moline, Illinois
Book Editor's Note
Dr Beth Shelly has an excellent suggestion for use of this book as a workbook for the patient not only to use it independently but also to use it along with his or her therapist during active PT sessions, or in a series of educational classes lead by a physical therapist.
Rebecca Stephenson, PT, DPT, WCS, CLT