Biopsychosocial Model of Pain
The International Association Society of Pain updated its definition of pain to state that pain is:
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Pain, November 2007
Traditionally, pain was explained as a biomechanical or Cartesian model, where pain was understood only in terms of tissue damage. As the experience of pain is unique for each person, the updated definition takes into account the person experiencing the pain. This led to the terminology of biopsychosocial model of pain. Basically, this meant that if the person said they were in pain, they were in pain. Being in pain did not mean that there was evidence of tissue damage.
This new understanding described pain as occurring when “the body’s alarm system alerts the brain to actual or potential tissue damage”. (Explain Pain by Moseley and Butler.)
The brain interprets these neural messages as “danger signals” from the body. This acts as an alert to you and that you should do something about it.
In a “biomechanical model” where pain is understood in terms of tissue damage there cannot be relief from pain, until the tissue damage is fixed. The meaning for the person experiencing the pain is that they need medication or some procedure to their body to stop the pain. This approach does bring relief sometimes, but often fails to restore confidence to the person to return to all their activities.
In real life situations sometimes tissue damage is obvious, for example in the osteoarthritic knee, but the person does not necessarily feel pain. We see disc bulges on X-ray and the person does not feel pain. We hear about soldiers in battle with bullet wounds to the leg who continue to run and fight.
But we also see the opposite, when six months after a sprained ankle some people cannot run and continue to experience pain. We see patients who, following a fall onto the back, never get back to work. Something more complex must be going on, in order why there is so much variation in outcomes.
There is something more complex going on that accounts for these variations in pain experiences.
Research and new technology has given us a deeper understanding to account for these variations that has helped in treatment of pain. This is where a biopsychosocial understanding of pain is giving relief of pain today. For example, it has been shown that patient understanding of pain helps in reducing pain. Neuroplasticity defined as the brain's ability to reorganize itself by forming new neural connections throughout life, means that we can have influence over outputs from the brain resulting in decreased pain. Understanding that movement is not dangerous can help in restoring function.
At Active Physiotherapy, we can help you use this new knowledge to decrease pain and return you to the activities that are important to you. It can restore confidence and control of your body.
This is a brief introduction to how understanding the biopsychosocial nature of pain can help you. At Active Physiotherapy, we have helped many people with chronic pain and disability, to return to an active life by working together with you and showing you how to actively participate in achieving pain relief so that you can return to the activities that you want to do.
Call David Fidler at Active Physiotherapy for further information or to make an appointment.