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What is the biopsychosocial model of pain?

 

This model argues that pain emerges from a dynamic interplay between biological, psychological, and social factors that vary from individual to individual. These factors are not mutually exclusive.

From Rankin, Linda. (2020). Chronic pain: from the study of student attitudes and preferences to the in vitro investigation of a novel treatment strategy.

What does the bio (biological) in the model refer to?

It refers to type and magnitude of nociception, tissue injury, damage or disease, physical health problems, genetics, immune function, neurobiology and neurochemistry, effects of medications, sex differences, nervous system characteristics (e.g. pain threshold, pain tolerance, predisposition to peripheral, and central sensitisation), hormones, sleep, age, and endogenous opiate systems.

It can also be used to refer to biomechanics, fitness (aerobic, strength, flexibility), and physical activity.

What does the psych (psychological) in the model refer to?

It refers to thoughts and emotions including learning and memory, perception/understanding of pain, beliefs and attitudes, unhelpful thought patterns (e.g. catastrophising), recovery expectations, past pain experiences, fear, pain self-efficacy, depression, anxiety, psychological distress, and coping skills.

What does the social in the model refer to?

It refers to educational attainment, social/family support, employment factors, finance/welfare issues, social deprivation/poverty, social disadvantage and exclusion stigma/discrimination, and cultural factors.

Are multiple disciplines required to deliver a biopsychosocial approach?

No, not necessarily. A single discipline can adopt a biopsychosocial approach to management depending on the modalities they choose to use. For example, combining medicine with talk therapy, exercise with reassurance.

However, depending on the country and the patient’s condition, an interdisciplinary approach (e.g. physicians, physiotherapists, psychologists, nurses, social workers working together as a team) may be required to formulate a proper diagnosis and management plan. 

Does pain assessment and treatment in Europe follow a biopsychosocial model approach?

It should, in that guidelines recommend this approach for the diagnosis and management of various pain conditions.

However, much evidence demonstrates that many patients across Europe receive a purely biological (also called biomedical approach) to their pain. This can frequently involve the use of unnecessary or harmful medicines and procedures, with little attention given to psychological or social factors.

Access to non-medical treatments (e.g. exercise therapy, psychological treatment) and waiting lists can be problematic in some countries, and so many people can miss out on a more holistic biopsychosocial plan.