Richard W. Hanson, Ph.D.
The biopsychosocial model (viewpoint) of pain is offered as an alternative to the predominant biomedical model. The biomedical perspective on pain, which is held by many if not most medical doctors and the majority of chronic pain patients, views pain as solely explainable in biological or medical terms. The biomedical model acknowledges that mental or emotional problems may result from chronic pain, but maintains that the pain itself is entirely biological in origin. The biomedical model also assumes that the only truly effective treatment for pain involve medical approaches.
We believe that a more complete understanding of pain must take into account not only biological, but also psychological, and social factors. Biological refers to the medical or physical aspects of pain. Psychological refers to the mental, emotional, and behavioral aspects of pain. Social refers to your interactions with other people. According to the biopsychosocial model, it is impossible to fully understand the problem of pain using physical or medical concepts alone. Unlike the biomedical model, which separates body and mind, biopsychosocial is a holistic perspective in that mind and body are seen as automatically intertwined.
The following diagram illustrates the interactions among the various aspects of pain:
Basic Elements of the Biopsychosocial Model
Following are brief descriptions of each of the elements of the biopsychosocial model:
Sensory
This refers to the physical sensations which make up the experience of pain. They can be described on four key dimensions: 1) location - where on your body the pain is experienced, 2) intensity - how intense the pain is (e.g., ranging from mild to excruciating), 3) quality - the qualitative nature of the sensations (e.g., dull, aching, sharp, burning, stabbing), and 4) time - how the sensations vary over time.
Emotional
This includes all of the emotional states which accompany the experience of pain, as well as the effects of pain on your life. Examples include fear, anxiety, worry, discouragement, depression, despair, guilt, anger, and irritability.
Mental
This includes awareness of pain, focus of attention, memories of pain and other experiences, expectations regarding the pain condition and your ability to cope with it, perceptions of ongoing life events, thoughts which accompany emotions, decision making processes, attitudes toward yourself and others, etc. Another word which we use for mental is cognitive.
Behavioral (Actions)
This includes all the things that you actually do in response to your experience of pain, ongoing emotional states, and the consequences of pain on your life. It also includes physical activities and social interactions which can affect your pain intensity as well as influence your thoughts and emotions.
Physical environment
This includes all aspects of the physical environment which affect your awareness of pain or ability to cope with pain. Examples may include weather conditions, housing conditions, physical objects such as beds and chairs, availability of money and other material resources, means of transportation, etc.
Social environment
This refers to all individuals who can affect and are affected by your pain condition. It includes family and friends, medical care providers, representatives of the disability compensation system, etc.
Interactions
It is important to understand that each of these factors cannot be considered in isolation. That is, each element interacts with and is affected by each other element.
Vicious Cycles
One unfortunate way in which these elements often interact is to create vicious cycles. For example, pain sensations (Sensory) often result in decreased physical activity (Actions). Decreased physical activities can create feelings of depression (Emotional) and decreased self-worth (Mental). The depression can lead to decreased motivation and initiative and even less activity (Actions). Decreased activity, accompanied by withdrawal from other people (Social), leads to even more depression (Emotional), preoccupation with negative thoughts (Mental), and increased awareness of pain (Sensory).
Positive Cycles
Fortunately, the interactions among these elements can work in a positive way as well. Even though it is difficult to directly control your painful physical sensations and negative emotional reactions, you can significantly affect both by altering your thoughts and actions. That is why in our pain self-management program we place primary emphasis on the mental and action components of the Biopsychosocial Model.