Biopsychosocial Theory For Chronic Pain

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The Biopsychosocial model was first conceptualized by George Engel in 1977, suggesting that to understand a person's medical condition it is not simply the biological factors to consider, but also the psychological and social factors.

By themselves, medical herbs used to address biological factors may not be enough. As an example, chronic pain may need to be viewed through the biopsychosocial lens.

Biological, Psychological, and Socio-Environmental Factors.

Since COVID-19 and its variants, the strain on individual mental health has led to escalating symptoms and diagnoses of depression and anxiety. Mental health consequences are not limited to the emotions or energy level of a patient; they extend to their physical and social health, as well.

Doctors and scientists alike recognize a relationship between these aspects of our lives – the bodily, the mental, and the social. The “biopsychosocial (BPS) model” emphasizes the interconnection between biological, psychological, and socio-environmental factors.

Biopsychosocial (BPS) Model

When this model is applied to health issues, such as chronic pain, it demonstrates the importance of maintaining wellness in all aspects of our lives. It also emphasizes the inseparable relationships between these three factors (biological, psychological, and socio-environmental.) When one or more of the trio is disturbed, it can have direct and often negative impacts on the others.

The BPS model of wellness and medicine examines how the three aspects – biological, psychological, and social – occupy roles in relative health or disease. The BPS model stresses the interconnectedness of these factors.

Biopsychosocial Lens

While western medicine uses a biomedical approach to health, the Health Guardian prefers to evaluate health through a biopsychosocial lens. Quite simply, this approach includes the influences of biological factors, psychological factors, and social factors when looking at overall health. The biopsychosocial approach focuses on the biology or physiology underlying health; the psychology of thoughts, feelings, and behaviors influencing health; and the ways that society and culture all influence health. The biopsychosocial approach allows us to see how health changes not only biologically, but how your inner thoughts and feelings and the society around you influences your perception and determination of health.

So, what’s the big difference between a biomedical approach and a biopsychosocial approach? Well, when we break it apart, it comes down to cells vs societal influences. The biomedical approach takes health from a purely biological perspective. If this cell does this, then this is what happens to the body. If this muscle does this, then this must happen. But take a step back…is that really how health works? The biopsychosocial approach suggests that there is more.

A simple breakdown of this application may be as follows:

  • The Biological (bio) – often associated with the relationship of disease and bodily health. For example, a person may experience a hernia or lymphedema, or chronic pain which usually cause less severe but long-term health problems that must be addressed by a health professional. Acute and severe health problems, like an aortic dissection, require immediate medical treatment and have a much more disruptive effect on daily life.
  • The Psychological (psycho) – the aspects of mental and emotional wellness that also relate to behavior. In the pandemic, concerns about disease, quarantine and sudden lifestyle changes have been detrimental for those have experienced mental illness conditions like anxiety or depression. These new life dynamics have also impacted people who had not before experienced mental health problems. 
  • The Social (social) – these are interpersonal factors such as social interactions and community activities. Seclusion, whether intentional or not (as in a result of activity-limiting illness), has adverse impacts on a person’s ability to socialize or maintain healthy relationships with those outside of one’s home. Such deficiencies in social life can lead to feelings of isolation and an imbalanced lifestyle.

The BPS model states that relative health and disease is dependent on the interactions between these three factors. Their interplay thus determines the cause, manifestation, and resolution of some illness.

For example, the bodily health of a patient may be exacerbated by problems in their mental or social spheres of health. Illness may manifest in more extreme or chronic symptoms; it could be harder to treat effectively without addressing the issues outside of bodily health. By moving beyond the biomedical perspective of patient’s health, the BPS model recognizes the complex dynamic between biological, psychological, and social life circumstances, providing a more holistic view to address health problems.

In circumstances of extreme mental and/or social turmoil, research has found patients show lowered immune systems and healing processes. While rest, good diets and exercise are recommended for those patients healing from a surgery or recovering from an illness, the mental and social spheres of their lives can adversely impact or prolong the healing process. The BPS model thus provides one explanation if a patient is struggling to heal or maintain their health during a prolonged stress event.

This model is commonly used in chronic pain, with the view that the pain is a psychophysiological behavior pattern that cannot be categorized into biological, psychological, or social factors alone. There are suggestions that physiotherapy should integrate psychological treatment to address all components comprising the experience of chronic pain. 

While a Health Guardian considers using the perspective of a Physiotherapist to address chronic pain, they must know how biopsychosocial factors interact in chronic pain. They want to explain the perpetuation of chronic pain and use it as a basis for planning a pain intervention program.

A chronic pain intervention program would include rest and sleep, exercise, phytotherapy and other pharmaceuticals, nutrition, social interaction, and psychotherapy. Some questions that should be addressed during the intervention program are:

  1. TYPE of PAIN- For us to address chronic pain, and the psychosocial factors (that may or may not be modified), we need to understand and explain the predominant mechanism of our chronic pain. Classification should identify any
    1. nociceptive pain (which happens when nociceptors detect something that can cause harm to the body like a chemical, hot or cold temperature, or physical force).
    2. neuropathic pain(pain resulting from damage or dysfunction of the nervous system)
    3. non-neuropathic pain of central sensitization
  2. SOMATIC and medical factors- the physical examination is a very important part of the intervention – it’s essential to:
    1. Be aware that some findings of clinical examinations such as mobility, strength, neurodynamics, coordination, etc. could be altered because there is greater sensitivity to mechanical stimulation and modified movement patterns in patients with non-neuropathic pain of central sensitization.
    2. Main goal in this stage is to evaluate the quality of movement, if the pattern of movement causes the pain to persist and if there is kinesiofobia.
    3. Consider current or previous health conditions, the disuse of body parts, changes in movement patterns, exercise capacity, strength and muscle tone during movement, the action of the drug in the CNS It is useful for data collection.
  3. COGNITION / PERCEPTIONS- Both cognition and perceptions influence biologically on hypersensitivity in the brain by activating neuromatrix pain and influence the emotional and behavioral factors:
    1. Ask yourself about perceptions: expectations of the intervention, expectations of the prognosis of the pain, understanding of their situation and the strategies you have available to your situation, what the pain represents emotionally.
  4. EMOTIONAL FACTORS- Is fear of specific movements, avoidance behaviors, psychological traumatic appearance of pain, psychological problems at work, family, finances, society, etc. contributing to pain.
  5. BEHAVIORAL FACTORS- Can lead to avoid activity or movement due to fear, which in turn is presented as physical inactivityor disuse and, finally, disability. Therefore, it is important to evaluate the behavior and adaptations that have been made due to the pain.
  6. SOCIAL FACTORS- This refers to the social and environmental factors in which you develop, which could be useful and supportive or harmful and stressful for the improvement of your health condition. The data collection can be divided as follows:
    1. Housing or living situation
    2. Social environment
    3. Work
    4. Relationship with the partner
    5. Previous interventions

While western medicine uses a biomedical approach to health, health psychologists prefer to evaluate health through a biopsychosocial lens. Quite simply, this approach includes the influences of biological factors, psychological factors, and social factors when looking at overall health. The biopsychosocial approach focuses on the biology or physiology underlying health; the psychology of thoughts, feelings, and behaviors influencing health; and the ways that society and culture all influence health. The biopsychosocial approach allows us to see how health changes not only biologically, but how your inner thoughts and feelings and the society around you influences your perception and determination of health.

So, what’s the big difference between a biomedical approach and a biopsychosocial approach? Well, when we break it apart, it comes down to cells vs societal influences. The biomedical approach takes health from a purely biological perspective. If this cell does this, then this is what happens to the body. If this muscle does this, then this must happen. But take a step back…is that really how health works? The biopsychosocial approach suggests that there is more.

In 1977, George Engel argued that well-being includes the effects of psychological, behavioral, and social dimensions. His biopsychosocial approach advocates for the necessity of treating and thinking about illnesses by including the social and behavioral factors that play a role in overall health (e.g., poor eating habits and obesity, smoking, stress/anxiety/depression, etc.).

Here is an example of how a biopsychosocial approach differs from a purely biomedical perspective.

Smoking:

  • BIOMEDICAL APPROACH: A biomedical approach analyzes smokers from the biological perspective and reasons for smoking: addiction or heritability. However, we can see from a biopsychosocial approach that there are many reasons that people start smoking, and they are not necessarily from a biological origin.
  • BIOPSYCHOSOCIAL APPROACH: People may start smoking for PSYCHOLOGICAL reasons, such as thinking it makes them less stressed or because of personality traits (extroverts are more likely to smoke). People may start smoking due to SOCIAL networks or perceived cultural norms. Finally, we still must note that addictions and heritability are BIOLOGICAL components that can contribute to smoking behaviors.
  • Biopsychosocial assessments are based on the biopsychosocial model proposed by Dr. George Engel in 1977. According to Engel's model, a person's biological, social and psychological factors are all intertwined and influence their well-being. In other words, a person's body and mind are not separate entities.
  • For example, if a patient experiences a physical illness while lacking social support, they may become depressed or anxious. Similarly, if a person has depression, they might withdraw from their friends and family and neglect self-care, impacting their physical and social wellness.
  • Mental health professionals recognize the need to view clients holistically and consider how various aspects of a person's life might contribute to a mental health issue, impair the functioning or maintain a disorder.
  • A biopsychosocial assessment helps counselors, social workers, and other behavioral health professionals learn about their clients on multiple levels and better understand their subjective viewpoints. As a result, biopsychosocial assessments enable therapists to diagnose and effectively treat their clients.
  • Mental health professionals typically conduct a biopsychosocial assessment as part of the initial assessmentwith clients. If you would like to use biopsychosocial assessments to learn more about your clients, we have information to help you get started. In this post, we'll explore the components of a biopsychosocial assessment, questions to ask clients, and how to write a report.

 

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