More Than Pain: Why Osteopaths Embrace the Biopsychosocial Model
As an Osteopath, we work with pain every day. Patients often seek our help primarily because they are experiencing some kind of pain or discomfort and want relief. You might wonder why, if your lower back hurts, I am asking about your diet, your general mood, your level of fitness, and other aspects of your life. The reason is that pain is a complex and multifaceted experience influenced by a combination of biological, psychological, and social factors. Osteopathy’s approach to pain is rooted in a comprehensive framework known as the biopsychosocial model. To provide the most effective treatment, it is essential to understand the bigger picture and consider all elements that may be contributing to your pain. By addressing your overall health and well-being, we can create a comprehensive and personalised treatment plan that not only alleviates your current symptoms but also promotes long-term health and prevents future issues. Let’s delve into why this model is so integral to osteopathy and how it sets us apart from other therapeutic approaches.
What is the Biopsychosocial model?
The Three Pillars of the Biopsychosocial Model
1. Biological Factors:
- Physiological Processes: Our body’s nociceptive system, responsible for detecting and processing pain signals, plays a crucial role.
- Genetics: Genetic predispositions can significantly influence our sensitivity to pain and how we perceive it.
- Medical Conditions: Conditions such as arthritis, fibromyalgia, or injuries that directly cause or contribute to pain are central to the biological aspect.
- Diet influences both biological, psychological and social aspects of pain management. Biologically certain foods can help reduce or increase inflammation and pain levels, especially in conditions like arthritis and fibromyalgia. Psychologically, a healthy diet can improve mood and energy levels, reducing the impact of stress, anxiety, and depression, which are known to exacerbate pain. Socially, dietary habits are often influenced by cultural norms and socioeconomic factors, affecting access to healthy food options.
2. Psychological Factors:
- Emotions: Feelings like stress, anxiety, and depression can exacerbate pain.
- Cognitive Processes: How we think about pain, whether we catastrophise (expect the worst) or feel hopeless, profoundly impacts our pain experience.
- Behavioural Responses: Our responses to pain, including coping strategies, seeking treatment, or avoidance behaviours, are critical to understanding pain dynamics.
3. Social Factors:
- Social Support: The presence or absence of support from family, friends, and the community can influence pain perception and management.
- Cultural Influences: Cultural attitudes and beliefs about pain affect how pain is expressed and treated.
- Socioeconomic Status: Access to healthcare, financial stability, and occupational factors play a role in pain management and outcomes.
Why Osteopaths Look at the Bigger Picture
Holistic Approach: Unlike the traditional biomedical model, which focuses solely on physical and biological factors, osteopaths embrace the full spectrum of influences on pain. We understand that physical health, mental state, and social environment all play crucial roles in the pain experience.
Interdisciplinary Treatment: The biopsychosocial model supports multidisciplinary treatment approaches. As osteopaths, we often work alongside other healthcare providers, combining medical, psychological, and social interventions to manage pain more effectively.
Individualised Care: Every patient is unique, and so is their pain. The biopsychosocial model encourages personalised treatment plans tailored to the unique combination of factors affecting each patient’s pain experience, leading to more effective and patient-centred care.
Emphasis on Psychological and Social Factors: By incorporating psychological factors such as emotions, thoughts, and behaviours, as well as social factors like support systems and cultural influences, we provide a more complete understanding of pain dynamics.
Evidence-Based: Extensive research supports the biopsychosocial model. Studies show that integrating these different dimensions leads to better pain management outcomes compared to models focusing on a single aspect of pain.
Adaptability: The biopsychosocial model is versatile and can be adapted to various types of pain, including chronic pain, acute pain, and pain associated with different medical conditions. This adaptability makes it applicable across diverse clinical settings.
Here is an example of how the Biopsychosocial approach to Pain Management
Background
Jane is a 45-year-old woman experiencing chronic lower back pain for over a year. She works as an administrative assistant, which requires long hours of sitting. Her pain has become debilitating, affecting her work performance and quality of life.
Biological Factors
- Physiological Processes: Jane's chronic pain is partly due to degenerative disc disease, identified through MRI scans.
- Genetics: Her family history reveals that her mother and grandmother also suffered from similar back problems.
- Medical Conditions: In addition to degenerative disc disease, Jane has been diagnosed with mild osteoarthritis in her spine.
Psychological Factors
- Emotions: Jane feels anxious and depressed about her ongoing pain, which seems to have no end in sight.
- Cognitive Processes: She tends to catastrophise her pain, worrying that it will only get worse and fearing it will lead to permanent disability.
- Behavioural Responses: Jane has started avoiding physical activity, fearing it might aggravate her pain, which in turn has led to weight gain and decreased physical fitness.
Social Factors
- Social Support: Jane feels isolated because she cannot participate in social activities she once enjoyed, like hiking with friends.
- Cultural Influences: In her culture, there is a stigma associated with chronic pain, which discourages seeking help for what is perceived as a personal weakness.
- Socioeconomic Status: Jane’s financial constraints limit her access to various treatment options, and her job requires her to maintain long hours of sitting, exacerbating her condition.
Multidisciplinary Treatment Plan
To address Jane’s pain comprehensively, an osteopath designs a multidisciplinary treatment plan that integrates the biopsychosocial model.
Biological Interventions
- Manual Therapy: Regular osteopathic treatments to alleviate pain and improve spinal function.
- Physical Therapy: A tailored exercise program to strengthen her core muscles and improve her posture.
- Diet/ Pain relief: Non-steroidal anti-inflammatory drugs (NSAIDs) prescribed for managing inflammation and pain.
Psychological Interventions
- Transactional Analysis (TA): Sessions with a therapist trained in TA to explore and improve Jane's emotional responses and interpersonal relationships.
- Transactional Patterns: She explores the transactions (interactions) she has with herself and others that may be reinforcing negative thoughts and behaviours related to her pain.
- Mindfulness and Relaxation Techniques: Practices like meditation and progressive muscle relaxation to reduce stress and anxiety related to her pain.
Social Interventions
- Social Support Groups: Participation in a support group for individuals with chronic pain to share experiences and strategies for managing pain.
- Ergonomic Adjustments: Modifications at her workplace, such as an ergonomic chair and regular breaks to stand and stretch, to reduce strain on her back.
- Education and Advocacy: Helping Jane understand her condition better and advocating for reasonable adjustments at work to accommodate her needs.
Outcomes
After several months of adhering to this comprehensive treatment plan, Jane begins to see significant improvements:
- Reduced Pain Levels: Her pain intensity decreases, making it more manageable.
- Improved Mental Health: Jane reports feeling less anxious and depressed, thanks to the insights and strategies gained from TA.
- Increased Activity: She resumes physical activities with confidence, enjoying short hikes and social outings again.
- Better Work Performance: Ergonomic adjustments and regular breaks improve her comfort and productivity at work.
Jane’s case exemplifies the biopsychosocial model in action, with a focus on transactional analysis for psychological intervention. By addressing not just the physical aspects of her pain but also considering her psychological state and social environment, the multidisciplinary treatment approach leads to a more holistic and effective management of her chronic pain. This example highlights the importance of looking at the bigger picture, a principle that is central to the practice of osteopathy.
There Are Alternative Models of Pain
While the biopsychosocial model is widely accepted for its comprehensive approach, there are other models that offer different perspectives on how pain is experienced and managed:
- Biomedical Model: Focuses solely on biological and physiological aspects of pain.
- Psychosocial Model: Emphasises psychological and social aspects.
- Neuromatrix Theory of Pain: Suggests pain is a multidimensional experience generated by a network of neurons in the brain.
- Gate Control Theory: Proposes that pain signals are modulated by a "gate" mechanism in the spinal cord.
- Cognitive-Behavioural Model: Focuses on how thoughts, emotions, and behaviours interact to influence pain.
- Behavioural Model: Looks at pain in terms of learned behaviours and their consequences.
Each of these models provides valuable insights and can be used in conjunction with each other to offer a more tailored approach to pain management.
The Osteopathic Commitment
At Holland Osteopathy, our commitment is to look beyond the immediate physical symptoms and consider the broader context of each patient’s pain. The biopsychosocial model equips us with the framework to do just that, ensuring that every aspect of a patient’s well-being is considered in their treatment plan. By embracing this comprehensive approach, osteopaths are uniquely positioned to provide holistic and effective pain management, addressing not just the symptoms but the root causes of pain.