Hello! Today I will tell you a bit about pain and the biopsychosocial model. The objective of today's lesson is to introduce the biopsychosocial model and how it can help pain assessment and, also, in identifying factors that hinder patients' fast recovery after pain episodes.
But what is the psychosocial model? The biopsychosocial model is a model that broadens the way to carry out pain and health condition assessment. Until now, we understood that pain is a very complex and individual experience.
We need to evaluate all biological aspects, all psychological aspects and all socio-environmental aspects that involve the context of a person in pain. So, pain is the result of all these factors interacting together. How did the biopsychosocial model emerge?
Until the 1970's, we, health professionals, used a model called the biomedic model. This model focused on curing. This model was also called hospital-centric, in which health care was entirely performed inside health systems and hospitals.
This system aimed at curing an occurring illness or at finding the causal factor, such as a virus. So, every clinical condition needed to have a cause. In the biomedic model, illnesses or viruses were treated in very specific ways, with specific medication and surgeries.
In this model it was like I broke a car piece and the solution is to substitute the piece. We call it a mechanistic model, since it views the body as a machine composed of several parts. When a part breaks, I substitute it.
But this model failed at explaining the situation of some patients. So, in 1977, a psychiatrist called George Engel published a study about a new approach to the concept of health in a famous scientific journal of the health field. He urged theorists, researchers and clinical professionals to broaden their views on people's health conditions.
In the model proposed by Engel, the biopsychosocial model, he proposed we evaluate people more extensively than just looking at their body functions and structure. But for us to also comprehend the context the person in question is in. All influence from environment, social and psychological aspects that influence people's health.
But why should we use the biopsychosocial model to evaluate someone's pain? Because the biopsychosocial model thoroughly evaluates three big aspects: biological, psychological and social aspects. Among the biological aspects, we can't not evaluate a compromised structure, the causal factor, we can't overlook this.
But we should expand our evaluation to include, for example, psychological factors, the person's mental health, the way they face life's situations, their relationship with their family, their work relationship and other situations related to psychological aspects. We also expand our evaluation by looking at social aspects of patients in pain. Are there socioeconomic factors that influence this person's life, that may be maximizing their pain?
Are there cultural factors, beliefs that may influence this patient's pain? So, we are able to broaden our view on the person's pain and, this way, individualize it and individually treat their pain too. So this leads to the question I’ve been meaning to make: would you feel safer and more satisfied if a health professional tried to better understand your pain complaint?
If they were able to understand how you think and how you feel? Or the toll pain takes on your life? I think it would be much better, right?
In 1977, Engel proposed the biopsychosocial model, and in 2001, the World Health Organization classified, published a booklet named International Classification of Functioning, Disability and Health, that contains this model. We use this booklet to expand how we evaluate pain. This ICF booklet shared concepts by approaching people with clinical conditions, health conditions in much broader ways.
But, as according to the ICF, what would be a health condition? Diseases aren't the only health conditions, diseases, injuries and circumstances are health conditions. I'm going to give you a practical example.
Is a pregnant person a sick person? Or is an elderly person necessarily ill? No, because there are life circumstances.
So, when we use broader perspectives to approach patients, supported by the ICF and the biopsychosocial model, we can understand that problems may happen in many different life circumstances and aren't specifically related to injuries and illnesses. We should also understand that the ICF applies to everyone, to healthy people and to people with any health conditions. So, what changes when we evaluate a person's pain through the biopsychosocial model published by the ICF?
What changes is that we have a broader understanding of these domains and influences, as psychological, social and environmental aspects can influence an individual's pain. It's important to also understand that the ICF isn't only used by health professionals, it can also be used by the person in pain to try to understand better their own symptoms and signs too. In addition, the ICF enables us to investigate psychosocial factors and I want to direct our attention to this, as these are important factors, because now we know that, by monitoring psychosocial factors, we can understand why some people recover quickly after a pain episode and why other people stay in pain for long periods.
So, the psychosocial factors are deemed as warning signs in the health field. They are deemed as warning signs because, like code yellow, they flag can anything that may hinder the treatment or prognosis of a patient in pain. Nowadays, we also know that treatments or intervention that use the biopsychosocial model approach and that explore the psychosocial factors of pain are more efficient than treatments that don't question patients in this manner.
So, it's important to evaluate some factors that we consider to be warning signs. I'm going to give some examples now. These are warning signs, patients that have such behaviors, beliefs or other thoughts, tend to be take longer to recover.
Take a look at this. There is a warning sign called catastrophizing. Patients, when we talk to them, to people that experience pain, we talk to these people and they tell us that they think the pain will never go away, that their pain is worse than that of other people.
This is a warning sign. We need to note code yellow signs. Another possible behavior is hypervigilance.
When a patient has hypervigilant behaviors, they are constantly focusing on how they sit down, how they get up and how much pain they're feeling. This is also a sign of bad prognosis. Another another sign is kinesiophobia, the fear of moving.
The patient is afraid to lean forward, to raise their arm and feel pain. They are afraid to move. And the fear is excessive, which leads to another behavior, called avoidance.
The patient starts to avoid doing certain movements, they avoid exercising, leaving their home and they end up developing sedentary behaviors. Aspects related to beliefs are also identified as warning signs. Some beliefs limit treating people in pain.
For example, believing that they can't perform impact activities, believing that the person in pain needs to be in absolute rest, believing that people with, for example, knee pain can't squat down. We should also face other warning actions, such as patient encouragement, self-efficacy and their ability to cope, which are all personal characteristics. Some patients believe they are able to manage pain and maintain treatment and, when encouraged, they can do this properly.
But some other patients, even when encouraged, don't feel as they are able to follow through with their treatment recommendations. This is also a sign of bad prognosis. We also need to evaluate the patient's psychological characteristics.
Is the patient acting in a depressed manner? Are they depressed, anxious or bipolar? Such psychological aspects may influence a patient's treatment.
So, in today's lesson we learned that it's important to consider the biological factors, psychological factors, social factors and environmental factors present in the patient's context. It's important to consider this in order to create more individual treatments. For this class I have only tackled psychosocial factors.
And, in the next lessons, I will address each of the other factors in more depth. Keep in mind that we call psychosocial factors as warning signs and they point out bad prognosis for chronic pain treatment. Thank you so much!
[Thank you!
