The Biopsychosocial Model in Chronic Pain.

From Pascal Grolaux, BSc, DO, MOst.

Historically, the concept of pain, even chronic pain, depended on a linear relationship between identifiable organic pathology and patient-reported symptoms. Thus, the amount of pain was expected to be perfectly proportional to the amount of tissue damage “causing” the pain. Psychological factors were presumed to be primary mechanistic contributors to pain only in those cases where no identifiable pathology was present and the pain could be labeled as “psychogenic”.

Over the past 4–5 decades, however, a biopsychosocial understanding has come to dominate the scientific community’s characterization of chronic pain. One of the biopsychosocial model’s strengths is its flexibility, and the term has undergone substantial reconceptualizations over the past half-century. In a 1977 article in Science, psychiatrist George Engel called for a new “medical model” that would supplant the old biomedical model of disease and would incorporate social, psychological, and behavioral dimensions of illness.

The biopsychosocial approach describes pain and disability as a multidimensional, dynamic interaction among physiological, psychological, and social factors that reciprocally influence one another, resulting in chronic and complex pain syndromes.

Longitudinal, observational research supports a strong bidirectional link between mood disorders and persistent pain; the development of an enduring pain condition confers a substantially increased vulnerability for the subsequent diagnosis of an affective disorder, while psychosocial variables such as depression, anxiety, and distress are among the most potent and robust predictors of the transition from acute to chronic pain.

There are bi-directional interactions between the autonomic nervous system (ANS) and pain. This is likely underpinned by a substantial overlap between brain areas of the central autonomic network and areas involved in pain processing and modulation.

Patients with chronic pain conditions such as fibromyalgia often show reduced HF power in addition to increased LF and LF/HF, suggesting dysregulated autonomic cardiac control. HRV analysis is good mean to assess the sympatho-vagal balance in patients suffering from chronic pain.

There's also a bi-directional interactions between the ANS and the immune system. A dysregulation of the ANS will impair immune protective processes that can lead to autoimmune disorders.

In the course "PAIN: From Clinical, Assessment and Management Perspectives" we will see how to approach the model, to presume a possible dysregulation and what osteopathic strategy could be implemented in order to harmonize the model and act on the systems involved in promoting and sustaining chronic pain.

Please see when the course is scheduled and join us now!