What Do You Know?

I have a bit of crowd-sourcing to do, just to satisfy my own curiosity, if you’ll indulge me by replying in the comments.

In your understanding, what is the biopsychosocial model of pain management? Have you ever heard of it? Has a health professional used or explained the term to you? What do you think it involves? Whether you’ve heard of it or not, what’s your best guess as to the best way to treat chronic pain? It doesn’t matter if you have no idea, I’d like to hear about that too!

In my recent reading I’ve been seeing a lot that suggests health professionals and patients might have incompatible perspectives on pain, which may be causing some of the communication issues that can arise. I’d be really interested to hear your thoughts, particularly given that I expect all of my readers are patients and also pretty well self-educated via internet resources. And thank you for bearing with me while I read ALL the articles! 🙂

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5 thoughts on “What Do You Know?

  1. Jackie

    I’ve never heard of that model. It depends so much on what limitations are placed on a given person from their condition… But I think combining pain medication and anti-inflammatory medication (a combo of pharmaceutical and natural medicines), diet, and hoping these changes allow for exercise which I think helps a lot of the time is the best way. I think the worst way is giving the patient only one option as to pain management when there are several available. I’ve had the best luck getting doctors to understand pain by explaining how it limits me compared to my pre-sick self and good days versus and days.

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  2. sunlight in winter

    Personally, I have somewhat of a negative connotation towards the word “biopsychosocial.” I know it’s supposed to reflect a “new” approach to pain management that focuses on the whole person, not just the symptoms. I know this way of looking at things is supposed to be better, because it is broad and acknowledges the fact that many factors contribute to pain.

    But in my own search for answers, this concept seems to have only gotten in the way. Sometimes being specific is good. Sometimes you really need a physician to focus on the “bio.” In the case of chronic pain, the physical causes aren’t always straightforward, so doctors focus on the “social” or the “psycho” aspects, which are easier to treat (and don’t require them to put themselves on the line by giving out pain medication).

    I could be wrong about this. I figured you wanted people’s immediate reactions to the word, so I didn’t do any reading before answering. Hope this was helpful!

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  3. edsdiaries

    I think the Biopsychosocial model of pain has its pro’s & cons. Pro’s being that the doc/consultant/health professionals take a broader stance when it comes to listening to a patient, understanding & treating. When you go to a doctor you want to explain your pain but you also want to make them understand what an impact it is having on your day to day life. So in turn you are hoping that the doctor understands the bio bit (pain mechanisms) the psychological aspect (how you feel re your pain & your outlook on it & life) & the social side (impact on daily life). If they are able to understand this they are able to treat you as an individual rather than concentrating on the biological aspect. For example, I presented with all the classic signs of a slipped disc yet my MRI showed a herniated disc a bit of degeneration but nothing that would suggest I should be in the pain I am. 4 years of doctors just looking at the bio basis didn’t get me far. Not until I saw a super specialist who took EVERY aspect of my pain & life into account. Now I am being offered various treatments for the bio, the psych & the social.

    HOWEVER. The Biopsychosocial model is in no way perfect in my opinion.

    1. Physio. Nearly always referred to them if you present with pain. NHS physio didn’t do it for me. Not always interested in the cause or where your pain is & how it’s affecting you-they just do their standard treatment for back pain/chronic pain etc & expect you to get better!
    2. Heavily focus on MRI/scan results & move on from there. If there isn’t anything significant there I am worried a psych approach may be used such as CBT, counselling & the actual cause of the pain may be forgotten.
    3. Work. Pain can greatly affect your work life-8 hours a day, 5days a week can feel like running 100 marathons in a week. Occupational health can come in & try to make things easier but if it doesn’t what’s next? Stop working?
    4.Life. Life doesn’t stop & neither can you,pain or no pain. If you’re dosed up it makes life hard. Socialising becomes hard & an effort, you stop doing things you enjoy because its not worth the repercussions of pain after. A psych approach would say this is unhealthy & no way to live-just crack on with life & put up with it.

    You go to the doc because you are in pain & it is affecting your life & work. You are drugged up so that functioning at work & in life becomes hard. You are tired from dragging yourself around & you are tired of the pain. You stop doing things because you take more meds to stop the pain which in turn stops you living your life as you would have pre-pain & stops you wanting to work because of how drained you are.

    The long & short of it-treat the source of the pain, don’t just cover it up. This unfortunately is unrealistic. More research needed into the anatomy & mechanisms involved in typical & atypical pain. The term Biopsychosocial model sounds good but I am not convinced its going to revolutionise the treatment of pain. It is just getting the doctors to take into consideration the impact pain can have on a life. Making each patient a bit more individual.

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  4. Mommabel

    I have had chronic pain for over 7 years. If you count the years that I’ve had migraines, its something like 17 years. I am a nurse, but I graduated 10 years ago. The prevailing theory at that time was the gate control theory of pain. That its all neurotransmitters and substance p. As a nurse, I was trained to believe that “the patient’s pain is what he/she says it is” and that there is really no way of quantifying the pain that another person is experiencing.

    When I worked in critical care, I learned that there are biological responses to pain. I frequently took care of patients who were in comas. They obviously can’t tell you where the pain is, or that they are having pain. But it was in that setting that I was taught to look at things like heart rate, body movements, facial expression. I also learned that just because someone is asleep, doesn’t mean that they don’t have pain. I often had to explain this to interns and residents because they wouldn’t order pain meds along with the paralyzing agent.

    And in hospice, I learned all about pain management. Mainly for cancer type pain. For that type of pain, here in Texas, we use a combination of narcotics, anti-inflammatory and neuromodulating medications. For cancer with a known bone component, we use steroids as well.

    That’s my professional life. In my personal life, I have learned that I need a combo of neuromodulating medication (Lyrics or pregabalin) every day with a strong non-narcotic for breakthrough pain (tramadol). And exercise. And sleep. I rarely take the tramadol, but it is extremely helpful when exertion or lack of sleep or something else just completely exacerbates my usual pain.

    I accepted a long time ago that I will probably have some level of pain every day of my life. Its just a matter of what is tolerable.

    I can no longer take frequently prescribed anti-inflammatory medication (Aleve, Lodine, even ibuprofen) because I now have one of the most common side effects for this class of meds: gastrointestinal inflammation. I have had some small bleeds in the past that were stopped with a two week course of Nexium.

    My migraines, on the other hand, are not my everyday pain (thank God). But since i have had to cut some of my prescription meds due to cost, they have increased significantly. I am supposed to be taking an antiseizure (Topamax) to prevent the migraines, but the dose that I require is pretty much at the near upper level of the recommended dosage. As a result, it would be $800/month (even though it is generic). I have been able to cope with a pharmacy program that distributes meds for free, and I now have a three month supply of Treximet. It combines an antimigraine medication (imitrex) with naproxen (which again, I have to be careful with). So it remains to be seen if I can continue taking it. But it is the only medication that I have tried in the past 17 years that promises full relief of the migraine in a few hours.

    I’m not sure if this answers your question. But maybe it will provide some insight.

    No, I have never had a “formal” discussion with any of my docs regarding pain medication. They all know I’m a nurse and they usually trust me when it comes to reporting what is going on with me in a factual way. They know my personal goal of trying to stay off narcotic medication at all costs (with the exception of pain that I know will subside. I had a concussion two years ago and I was on hydrocodone for a few months).

    I just recently started incorporating more exercise now that I feel physically able to tolerate it. I can’t say enough about yoga and strengthening exercises that helps to diminish my daily pain.

    I have also seen my husband (who has two herniated discs in his lower spine) take his everyday pain to nearly zero through vigorous exercise and conditioning. His goal is to never go under the knife for that condition, and he has lived 10 years without having to. He focuses on core strengthening and that has been one of the major differences in his pain. He has a very strong core and as a result, the discs are less likely to slip out of place with everyday activity.

    The problem in the U.S. is an issue of prescribing. Doctors are far more willing to just write a script than help the patient discover the true cause of their pain. They are also less likely to discuss alternate modes of therapy, such as the exercise, supplements, massage, acupuncture (I have done all of those). Then the cycle of medicating and not exercising comes in to play.

    I could write more and more and more but I think this is too long. Let me know if you want to discuss this further.

    Thank you for your site and your input!!

    Reply
  5. rachelmeeks

    Never heard of it. I know sadly little about how to treat chronic pain, except that eating right, taking vitamin supplements, and exercise helps. And that pain medicine should only be used when there is no alternative, i.e. you’re at a meeting and you can’t stretch, use a heating pad, lie down for a while, etc.

    Reply

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