Are You Missing Two-Thirds of Your Potential Pain Treatment Plan?

You've probably heard about the biopsychosocial medical model for managing chronic pain, but what does it mean and how can you start using it? 

After living with chronic pain for years – like me – you learn that finding something that works is a bit of a cat-and-mouse game. People in pain try all kinds of medications, supplements, injections, manipulations, and even surgeries – all in search of some type of cure or magic solution to ease their relentless pain.

But according to pain and health psychologist Rachel Zoffness, PhD, who wrote about the non-medical aspects of pain, we could be missing out on two-thirds of possible treatments that may actually be the key to relief.1 Dr. Zoffness serves as an assistant clinical professor at the UCSF School of Medicine.

But how can this be?

Western medicine has traditionally assumed that something is clinically wrong within the body that needs to be found and fixed. However, what we call “pain” is a multidimensional interaction of various, ever-changing biological, psychological, and social components that affect all aspects of our lives. (Image: iStock)

 

Western medicine has traditionally taken a biomedical approach to pain – essentially, we assume that something is clinically wrong within the body that needs to be found and fixed.

However, what we call “pain” is more than just physical. It’s a multidimensional interaction of various, ever-changing biological, psychological, and social components that affect all aspects of our lives. And as someone who has lived with fibromyalgia, IBS, neuropathy, sleep apnea, chronic fatigue, anxiety, depression (and more), I know that pain isn’t something that occurs at one point in time or even in one spot on the body. It’s not a level or a ranking on a scale. Pain is a lived “experience.” (See Tom’s no-nonsense tips for other pain champions.)

 

A More Comprehensive Body–Mind Approach

In 1977, Dr. George Engel proposed a new medical model to challenge and broaden the traditional biomedical model.2 It includes all three components of pain – biological, psychological, and social – to help better understand how pain works, assess patients, and treat them as complete and unique human beings.

He called it the biopsychosocial (BPS) model of medicine and healthcare providers are slowly moving to integrate this approach across medical disciplines, including in pain management.

Studies have shown that comprehensive pain treatment that addresses the biopsychosocial aspects of the pain experience is not only more clinically effective than conventional medical treatment by itself, it’s also more cost-efficient (see figure below).3-5 It’s no wonder the International Association for the Study of Pain (IASP), the National Academy of Sciences, and the US Pain Management Best Practices Inter-Agency Task Force all recommend comprehensive treatment for chronic pain.6-8

Inside the BioPsychoSocial Model for Chronic Pain Care

The “Bio” Part

The biological component of the pain experience refers to the physical body, genetic predispositions, and any correlating tissue damage, infection, or other physical stressors.9-12 It’s what many people typically associate with pain.  If we get hurt, we go to the doctor to get fixed.

To better understand this part of the BPS model and how it applies to you, ask yourself:

  • How many doctors have you seen regarding your pain?
  • How many x-rays or other tests have you had to diagnose your pain?
  • How much time have you spent researching a cause and cure for your pain?
  • How many pills, surgeries, and other interventions have you tried to relieve your pain?
  • Has your doctor recommended you rest and protect your body?
  • Have you lost muscle strength and endurance?
  • Do you still hurt?

The “Psych” Part

The psychological component of the pain experience refers to how you think about pain and your emotional and behavioral responses to it.9-12 The more limited you are by your pain (eg, being unable to get groceries or take a walk) and the more you think negatively about it, the worse it can feel and adversely impact your quality of life. It’s no wonder chronic pain patients are four times more likely to have depression or anxiety than patients who are pain-free.13

To better understand this part of the BPS model and how it applies to you, ask yourself:

  • How much time do you spend thinking about pain and how much it hurts?
  • Have you accepted the pain as your new normal or are you still fighting it?
  • Is it common for you to expect the worst (what pain doctors call “pain catastrophizing”)?
  • What verbal or nonverbal expressions do you show when you have pain? Do you moan, grimace, or rub the area that hurts?
  • Has pain changed your mood? Have you become anxious or depressed? Do you complain or get paingry?
  • Do you avoid activity in anticipation of pain or to prevent more damage to your body (what pain doctors call “fear avoidance”)?
  • Has fear of pain caused you to become guarded, brace yourself, or change posture?

The “Social” Part

The social component of the pain experience refers to your background, demographics, family attitudes, economic position, work environment, living situation, patient-provider interaction, and interpersonal relationships.9-12

To better understand this part of the BPS model and how it applies to you, ask yourself:

  • Is your access to pain care limited by insurance or geography?
  • Do you have any cultural beliefs about pain that affect your care?
  • What type of reactions do you get from the people in your life (e.g. family, friends, co-workers, medical team members)? Do they believe you? Do they get angry or frustrated? Or do they enable or coddle you?
  • Has pain affected the activities you enjoy, like exercise, hanging out with friends, doing hobbies, or going to movies?
  • Have you become isolated or have others isolated from you?
  • Do you have issues at work or have lost work or had to go on disability due to pain?

The three legs of a biopsychosocial model, courtesy of the author.Editor's Note: Dr. Roger Fillingim provides a more comprehensive model in his 2017 paper in the journal Pain, "Individual differences in pain: understanding the mosaic that makes pain personal."

 

How to Get Your Pain Care Plan up to 100%

By including all three components of pain – bio-psycho-social – you and your doctor, or clinic, can work toward getting the most comprehensive pain treatment.

Think of pain management as a three-legged stool like the one pictured above. Each leg represents one of the BPS model components: biological, psychological, and social. All three components are important to treatment. If one or more of the legs is missing, the stool will topple. And treatment won’t be as successful.

One way to get a full biopsychosocial approach is at a comprehensive interdisciplinary pain program, typically held at a regional or national pain center. These programs offer a combination of medical management, psychological cognitive behavioral therapy, psychological acceptance commitment therapy, occupational therapy, graded exercise, lifestyle management, and pain education to help pain patients better self-manage their pain and improve overall daily function. Read about my experience at one of these pain rehab centers.

But you can also talk to your doctor about expanding your pain management team in smaller ways, such as by getting a referral for a psychologist, a physical therapist, or other types of providers that you both feel may be helpful. While cost and insurance coverage may be a concern, expanded care is worth looking into and, in some cases, advocating for to get the best overall outcomes.

Building self-care into your pain management plan is also important – this can include things like exercise, relaxation or meditation exercises, and adding certain foods to your diet to help manage inflammation.

Remember, just as pain is a complete mind-body-life experience, your treatment plan should be as well.

Updated on: 09/30/20
Continue Reading:
How to Tap into Your Brain to Manage Your Chronic Pain
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