Cognitive Behavioural Therapy for Chronic Pain

Pain is rarely, if ever, “all in your head” — but what’s going on in your head (and your life) probably does affect pain, because pain is weird.1 It makes sense that a little head doctoring might be helpful.

The goal of mainstream psychological therapy for chronic pain is usually framed not as an attempt to actually treat pain directly, but to help people “live a full life with confidence in managing that pain.”2 Despite that disclaimer, many a psychologist has suggested to their clients that better coping can lead to lower pain levels, which in turn makes it easier to cope. Wisely or not, mental health professionals do often aspire to treat pain indirectly via that virtuous cycle.3

So what does the data say?

The data says “hell no”

A comprehensive 2020 review was extremely negative.4 Nothing is ever the “last word” in this business, but this paper comes close. It’s the latest of several versions and “by far the biggest,” with data pooled from 9400 trial subjects in dozens of experiments.5 It was mostly about three related methods:

1. cognitive behavioural therapy (CBT)
2. behavioural therapy (BT)
3. acceptance and commitment therapy (ACT)

The realm of mind-over-pain can be subdivided into many distinct but overlapping approaches, everything from meditation to hypnosis,6 but CBT, BT, and ACT are clearly the dominant mainstream approaches, and there wasn’t enough data about all other therapies combined to fill a bathtub, let alone a statistical pool with a deep end. So mostly this is about CBT and its cousins, ACT and BT — which seem different up close, but awfully similar from 20 paces away.

• see also
• reviews of healthcare professions
• anxiety and pain
• mind over pain

Cognitive behavioural therapy

CBT is the most studied type of psychological treatment by a wide margin, and it was found to have a “slight” benefit only, which is synonymous with a negative result. No one wants a dozen sessions of psychotherapy for a “slight” benefit. That is not a good return on investment. Ain’t nobody got time for that.

Interesting side note: CBT had terrific results in four papers. Those results were suspiciously good, and so they were excluded.7

It’s important to acknowledge that CBT is “technically” the leading evidence-based treatment for fibromyalgia (which is a more specific version of chronic pain: “a pattern of unexplained stubborn chronic pain, stiffness, fatigue, and mental fog”). There is probably more good quality evidence to support the efficacy of CBT for fibromyalgia than there is for any other treatment. Sounds good, right? But it isn’t saying much. If you read the fine print, it’s good evidence of a minor benefit: so minor, in fact, that the evidence of benefit “might not be clinically important to patients.”9 That’s a huge damned-with-faint-praise problem for CBT for fibromyalgia.

Behavioural therapy

There was much less data on behavioural therapy (BT, minus the C-for-cognition). It wasn’t adequate for a strong conclusion, nor promising. The absence of a clear positive signal is a negative signal.10

Acceptance and commitment therapy feels better than CBT (if nothing else)

The data on ACT is inconclusive — another kind of negative result.11 Williams et al. suggest that ACT — which has a vibrant community of practitioners — “has been propagated less on evidence than on practitioner enthusiasm.” Because what else is there? They obviously cannot base it on evidence!

The enthusiasm might be justifiable for reasons that don’t lend themselves to hard data, though. In ACT’s defense, it is focused on helping people live well in spite of pain, rather than treating pain. In other words, ACT in practice is more likely to contrains itself to the goals that CBT should be limiting itself to.12

On the quality of the data

I do not believe that I have ever seen a review that didn’t point out that the evidence is just a sorry mess. In this case, “a large number of underpowered trials with poor evaluation practices raise concerns about research waste.”

I think we’re past the point where that’s just a “concern.”13 But, in this case, there was so much data on CBT that there were enough good-apple studies to work with, and so at least one clear negative conclusion was possible.

Psychotherapy is still useful

Chronic pain often goes hand-in-hand with depression, anxiety, stress, sleep deprivation, and addictions — all of the systemic vulnerabilities that are probably an underestimated part of the pain puzzle.14 And while “all in your head” is perhaps the most hated “diagnosis” there has ever been, of course psychosomatic illness/pain does exist, and hopefully psychotherapy can help with that too.

Psychotherapy can probably reduce the suffering and disability caused by pain, even if there aren’t any clear downstream effects on pain itself. But there still could be! Just because it doesn’t happen on average (which is all the research can detect) doesn’t mean it never happens. It might work quite well with a therapist who is both skilled and lucky enough in how they try to help; it might work with the right patient, with the right kind of pain.

Trying to work around the evidence by claiming that a treatment works for special people, missed by the research, is a common foul in the world of pain medicine, especially about back pain.1516 But psychotherapy is a dizzyingly complex intervention, lots of variables, that might help some people when all the variables are just right.

In any case, psychotherapy is like massage therapy: it can be a pleasant and rewarding experience regardless of whether it can achieve specific therapeutic goals for pain. Its other benefits are, hopefully, complex and numerous.

But mental health care professionals probably should stop trying to treat pain — directly or indirectly — and just focus on helping people any other way that they believe that they can.

CBT as “glorified toxic positivity” or gaslighting

CBT might be useful at its best, but that’s highly speculative. What is not so speculative is that it can backfire by effectively blaming the patient. But don’t take my word for it. Alana Saltz, a writer and disability rights activist, brilliantly explains how she soured on CBT. I’ve highlighted a few points that I think are particularly excellent:

I received CBT therapy for many years, starting as a kid. It was years of being told that my emotional and physical pain was an overreaction due to distorted thinking. I wonder what it would have been like to have my pain heard, acknowledged, and validated instead?

It turns out, unsurprisingly, that I had many chronic illnesses that were previously undiagnosed due to my age, doctor bias, and lack of research around conditions. I had also experienced significant traumas that were not adequately explored or addressed by those therapists.

Yet the gold standard, go-to is CBT for everything, including PTSD and chronic illness. Even if you have physical symptoms and diagnoses or have experienced trauma(s), your response to pain is still gaslighted out of you. You’re assumed to be “thinking about it the wrong way.”

In my experience, and I’ve had a lot of it, CBT can be glorified toxic positivity. It doesn’t allow for fear or grief around illnesses and traumas. It encourages potentially ableist remedies like “getting out more” and “being social” when that might make certain conditions worse.

I’m not saying this to give therapists a hard time. I’m saying this because I want there to be more awareness and research around new modalities that have the ability to acknowledge emotional and physical pain without making someone feel invalidated and gaslighted.

We need to make sure that therapists aren’t engaging in bias, the same bias that many medical professionals can fall into, that trivializes and dismisses physical pain and trauma that would benefit from different modalities of therapeutic treatment.

I now use my concerns about CBT when consulting with a potential new therapist. I was pleasantly surprised when one recently agreed with me and said that modalities like CBT are based around outdated ways of thinking about pain and illness. I hope that means change is coming.

It’s not just CBT, of course: every kind of intervention that places the blame for pain and suffering on psychology can and has been used to gaslight patients. The mind is a very convenient scapegoat, and this can all be thoroughly disguised with good intentions.

That 2022 Pain Reprocessing Therapy study is way too good to be true

Pain Reprocessing Therapy (PRT) is a branded psychotherapeutic modality that’s a mashup of Sarno’s ideas, pain neuroscience education, and CBT.17 It got a huge marketing boost in early 2022 from an extremely positive trial published in a good journal.18

It was too positive. This study is deep in too-good-to-be-true territory. I urge people not to take these results at face value. The authors have very strong conflicts of interest and there are serious methodological flaws here. The only way I trust this result is when it has been replicated a couple times by researchers without quite so much skin in the game. For a more detailed analysis — especially a closer look at the rather glaring conflicts of interest — see my June 10, 2022, blog post: “That Pain Reprocessing Therapy study is way too good to be true.”

Can anti-depressants treat chronic pain?

It’s possible that anti-depressants can help a few people with some kinds of chronic pain. However, it’s much more common for people to get no clear benefit, while likely causing some side effects that add to their overall burden of suffering.19 A large 2023 “review of reviews” in the British Medical Journal found some low quality evidence that antidepressants might be helpful for a few kinds of chronic pain, but “no review provided high certainty evidence on the efficacy of antidepressants for pain for any condition,” and there was no evidence of benefit at all for the most chronic patients.20

Depression and chronic pain often seem to go together. The obvious psychological explanation for that is that chronic pain is extremely depressing. Much less obviously, pain and depression probably have some common causal roots in neuroimmune dysfunction (along with a variety of other common puzzling chronic illnesses). In other words, chronic pain isn’t just psychologically depressing, it may also be biologically depressing … and depression may be biologically painful.21 However, whatever goes wrong with bodies that might be both painful and depressing… unfortunately, anti-depressants do not seem to be able to treat that.

What about conventional pain treatment with a psychological spin?

Just because psychotherapy doesn’t seem to do much doesn’t mean psychology isn’t involved, of course. Pain still might be powered by a rich and funky stew of social and psychological factors as well as the biological ones, like injury and pathology. Treatment strategies inspired by the biopsychosocial (BPS) model of healthcare — a humanistic, holistic vision of care that tries to integrate psychological and social factors22 — have become quite fashionable in the last twenty years. So it’s worth testing them.

So, is BPS-ified pain treatment effective? Or is it just another faddish strike out? I think it’s fair to say we just don’t know yet. And you should not hold your breath until we do. But we do have some data.

Comic by Loren Fishman, HumoresqueCartoons.com

Understanding the “whole person” might be an important part of pain treatment. But it is not easy to understand whole people! Or cheap. And we don’t actually know how much it even matters.

A meta-analysis of pooled data from two dozen trials showed almost no differences between the results of BPS-inspired therapy and traditional “just physical” therapy: it’s all equally underwhelming.23 Specifically, “behavioral/psychologically informed interventions,” with or without physical ones added into the mix, performed just as poorly as physical treatments alone.

The meta-analysis is flawed (as most of them are), and it was harshly criticized in a letter to the editor. However, that complaint might be mostly a case of sour grapes, because the letter’s authors “know” that BPS-inspired treatments are effective (oh, if only). While those turf-defending motives are depressingly clear, everyone is probably right in some important way: nothing about the BPS model of pain, even if completely valid, suggests it’s going to be easy to treat it “biopsychosocially.” On the contrary, the model suggests it will be a beast to apply! But that doesn’t mean that it makes no sense and we shouldn’t be trying and checking.

Dr. Lorimer Mosely wrote of this kerfuffle: “The biopsychosociality of pain might not necessarily mean biopsychosocial treatments work.” And we should expect BPS-inspired treatment to be hard to standardize and test — because it’s messy by nature! Hell, that’s part of the point of the BPS model. And so the poor performance of “psychologically informed” treatments in the scientific literature so far is hardly any kind of a surprise, and BPS-inspired treatment could still have has unconfirmed virtues, could still be one of the least bad options we have for pain.

But it’s certainly not evidence-based so far, and it might never be.

Note that although this paper is from 2016, there has been nothing like it since. The penultimate big one was in 2014 (Kamper et al., focusing on back pain, and it concluded that “multidisciplinary biopsychosocial rehabilitation” was modestly effective — a bit less pain, a smidgen less disability — but also required a lot of time and resources, and was not clearly an overall win compared to more accessible treatments. So not really very effective.

What about CFT and RESTORE?

There is other relevant evidence, including the brand-spanking new (in spring 2023) and promising RESTORE trial of cognitive functional therapy,24 which is yet another version of BPS-ification of physical therapy. I am still wrapping my head around that one, but one thing is clear: while the results were unambiguously happy in some ways, the pain reduction was not impressive. CFT did well by other measures, like cost-effectively reducing disability. But it did not appear to treat pain any better than anything else does, and it had some flaws and limitations (as all science does) despite being generally pretty awesome. RESTORE does not settle this: it’s just the first strong data point in favour of CFT. More are needed, especially a placebo-controlled trial, before we can call CFT evidence-based medicine. It remains rational but experimental.

BPS-ing badly! How the biopsychosocial model fails pain patients

It’s also worth noting that healthcare professionals aren't actually very good at biopsychosocial care. BPS has always been more fashionable than functional. Clinicians have a tendency to talk the BPS talk, but not so much walk the BPS walk… and this has been going on for decades now. Ideal BPS-ified care from the most gifted pros might be efficacious, but good luck standardized it, but it is probably extremely difficult to find.

Cormack et al. offer some ideas about what has gone wrong, and what might be done about it — some BPS upgrades.25 It’s a fancy paper full of five-dollar words for things that most patients understand easily as the components of good bedside manner: healthcare that treats people not just with compassion, but like it matters who they are, like they have complex lives that are actually relevant to their care. 🤯 No one disagrees with that vision of healthcare. No one would dare! It sounds too wholesome and wise. But it does seem to go rather poorly in practice.

I have an substantial article dedicated to this topic. See BPS-ing badly! How the biopsychosocial model fails pain patients.

About Paul Ingraham

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:

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Related Reading

• Mind Over Pain — Pain can be profoundly warped by the brain, but does that mean we can think the pain away?
• Pain is Weird — Pain science reveals a volatile, misleading sensation that comes entirely from an overprotective brain, not our tissues
• Anxiety & Chronic Pain — A self-help guide for people who worry and hurt
• Why Do We Get Sick? — The curious and tangled connections between pain, poor health, and the lives we lead
• Chronic Pain as a Conditioned Behaviour — If pain can be learned, perhaps it can be unlearned
• The Art of Bioenergetic Breathing — A potent tool for personal growth and transformation by breathing quickly and deeply
• Pain Relief from Personal Growth — Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness
• Chronic Pain and Inequality — The role of racism, sexism, queerphobia, ageism, and poverty in health and chronic pain

Notes

1. More specifically, because pain is a perception: that is, it is an interpreted sensation, modulated by our hopes and fears and beliefs about its implications. Pain is weird because it’s volume affected by our minds … and our minds are weird.
2. EvidentlyCochrane.net [Internet]. Williams A. Managing chronic pain in adults: the latest evidence on psychological therapies; 2020 October 8 [cited 20 Oct 8]. PainSci Bibliography 51870 ❐

3. This reminds me a little of the claim of “facilitating healing.”

   The idea of facilitating self-healing is a cliché of alternative medicine. For example: “A healer just triggers your own ability to heal yourself.” It’s sacharine, silly, inspirational-poster nonsense. More technically, it’s a “deepity,” an idea that is either profound but wrong, or true but trivial. If healing actually could be “facilitated,” that would be miraculous.

   Facilitated healing is touted to make someone seem like a “healer” without coming right out and saying it, a “humblebrag.” It sounds humble, but it isn’t. It also rationalizes therapy that does not have a clear or specific mechanism.

   So what’s the connection with psychotherapy? It seems like a close cousin to “I’m not treating pain with psychotherapy, I’m just helping you treat it yourself.”

4. Williams ACd, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020 Aug;8:CD007407. PubMed 32794606 ❐

   I will lean heavily on this major review for this article. There are other sources and nuances to discuss, of course, but this is much more important than most.

5. A few technical notes: “Mindfulness” was excluded, as was treatment for headache. Only professional face-to-face delivery was considered. The researchers shunned small studies to avoid “a higher risk of unrealistically positive results.” The analyzed 75 studies — more than double the last version — representing 9400 people, two thirds women, mostly middle-aged, mostly with back pain, fibromyalgia, and arthritis.

6. This is my canonical list of mind-over-pain treatments:

   • Mainstream psychotherapeutic approaches, primarily CBT and ACT.
   • Problem solving, goal setting, graded exposure and graded reactivation.
   • Meditation/mindfulness, breathing exercises, relaxation.
   • The major branded mind-body medicine approaches like Sarno’s “mind over back pain” and Schubiner’s Pain Reprocessing Therapy.
   • Education, rational confidence building, pain neuroscience education (“explain pain”), SIMs/DIMs
   • Neuro/psych “hacks”: virtual reality, mirror therapy, hypnotherapy, biofeedback, EMDR, placebo, open-label placebo.
   • Distraction, pursuit of pleasure and happiness, catharsis/expression, art therapy (music, writing, dance, painting, etc).
   • Therapies that involve some physicality or sensory input, but seem to be more about their emotional/psychological benefits, e.g. gentle massage, touch therapy.
7. Why did they exclude them? Because they all came from the same source… and that source did not respond adequately to requests for clarification about their methods. So that’s four “positive” papers kicking around out there that were shunned by these reviewers. How many times do you think those papers have been cited to support CBT for chronic pain?
8. Johnsen TJ, Friborg O. The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis. Psychological Bulletin. 2015 May. PubMed 25961373 ❐

   The evidence of the benefit of cognitive behavioural therapy for depression may be declining over time: “modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials.”

   Or it may not be: the importance of the “decline effect” has probably been exaggerated. It’s also possible — and probably more likely — that CBT for depression is just following the pattern that we see with so many interventions: early excitement and bias produces "promising" results that are mostly the result of p-hacking and cannot be reproduced by later studies. This is practically standard.

9. Mascarenhas RO, Souza MB, Oliveira MX, et al. Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis. JAMA Intern Med. 2020 Oct. PubMed 33104162 ❐ Referring to CBT, antidepressants, and CNS depressants, the researchers concluded: “Some therapies may reduce pain and improve QOL in the short to medium term, although the effect size of the associations might not be clinically important to patients.” In fact, the associations between these treatments and good outcomes were “were small and did not exceed the minimum clinically important change (2 points on an 11-point scale for pain and 14 points on a 101-point scale for quality of life).”
10. Many seemingly evidence-based treatments for pain and injury are actually supported by evidence that damns with faint praise: results showing only a tiny benefit, which is usually not even real. Frustratingly, unimpressive evidence like this is routinely integrated into scientific reviews and clinical guidelines, which carry more weight with the uninformed. This pattern is practically standard in alternative medicine, sports medicine, and physical therapy. See Most Pain Treatments Damned With Faint Praise: Most controversial and alternative therapies are fighting over scraps of “positive” scientific evidence that damn them with the faint praise of small effect sizes that cannot impress.
11. When the data is adequate but only weakly positive, we can declare it to be effectively negative because of the lack of strongly positive results (see last note). But what about when the evidence is just inadequate? If there is a true absence of evidence — very few studies, or none at all, regardless of quality — then we cannot say much. But if there are more than a few studies, and the problem is just that they are too low quality, then it’s fair to declare a non-positive “result” … because genuine treatment effects probably won’t be missed by a bunch of low quality experiments that tend to err on the side of false positives. In other words, if a bunch of crappy papers cannot even produce a dubious positive, then it’s extremely unlikely that a bunch of highly quality ones will produce a real positive result.
12. Dr. Bronnie Thompson, a New Zealand occupational therapist with plenty of scientific savvy, wrote up a good explanation of the role of ACT in helping her with own pain, and how it contrasted with CBT (quite a bit).

    “[ACT] moves us away from working hard to avoid things we don’t like, and towards things that are rewarding to us. The influence of moving in the direction of things we want has a different flavour from avoiding things we don’t want.”

    In other words, it “feels” better, and that certainly is different from CBT. As different as training a dog with punishment versus reward. I definitely like the flavour of ACT better… at least as Bronnie explains it. She has a 6-part series, which starts here. Reading those is a nice ACT crash course.

13. I think it’s obviously a major problem, because the great majority of trials are clearly just junk. The scientific publishing industry is in pretty rough shape these days. See 14 Kinds of Bogus Citations, Statistical Significance Abuse, and Ioannidis: Making Medical Science Look Bad Since 2005.
14. Anything good for your general health has the potential to help chronic pain. The specific cause of chronic pain may often be less important than general sensitivity and biological vulnerability to any pain. The biggest risk factors for pain chronicity are things like insomnia, obesity, smoking, drinking… and they overshadow common scapegoats like poor posture, spinal degeneration, or even repetitive strain injury. How can nothing in particular make us hurt? Because pain is weird, a generally oversensitive alarm system that can produce false alarms even at the best of times, and probably more of them when your system is under strain. See Vulnerability to Chronic Pain: Chronic pain often has more to do with general biological vulnerabilities than specific tissue problems.
15. Saragiotto BT, Maher CG, Moseley AM, et al. A systematic review reveals that the credibility of subgroup claims in low back pain trials was low. J Clin Epidemiol. 2016 Jun. PubMed 27297201 ❐
16. Saragiotto BT, Maher CG, Hancock MJ, Koes BW. Subgrouping Patients With Nonspecific Low Back Pain: Hope or Hype? J Orthop Sports Phys Ther. 2017 Feb;47(2):44–48. PubMed 28142361 ❐

17. From the PRT website in mid-2022:

    Pain Reprocessing Therapy (PRT) is a system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. Pain Reprocessing Therapy has five main components: 1) education about the brain origins and reversibility of pain, 2) gathering and reinforcing personalized evidence for the brain origins and reversibility of pain, 3) attending to and appraising pain sensations through a lens of safety, 4) addressing other emotional threats, and 5) gravitating to positive feelings and sensations. See the treatment outline for Pain Reprocessing Therapy here.

18. Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022 01;79(1):13–23. PubMed 34586357 ❐ PainSci Bibliography 51974 ❐
19. Anagha K, Shihabudheen P, Uvais NA. Side Effect Profiles of Selective Serotonin Reuptake Inhibitors: A Cross-Sectional Study in a Naturalistic Setting. Prim Care Companion CNS Disord. 2021 Jul;23(4). PubMed 34324797 ❐
20. Ferreira GE, Abdel-Shaheed C, Underwood M, et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. BMJ. 2023 Feb;380:e072415. PubMed 36725015 ❐ PainSci Bibliography 51235 ❐
21. Thompson T, Correll CU, Gallop K, Vancampfort D, Stubbs B. Is Pain Perception Altered in People With Depression? A Systematic Review and Meta-Analysis of Experimental Pain Research. J Pain. 2016 Dec;17(12):1257–1272. PubMed 27589910 ❐
22. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr;196(4286):129–36. PubMed 847460 ❐

    This paper is the origin of the now famous biopsychosocial model of healthcare, advocating for a kinder, more nuanced and artful medicine, as opposed to the rather cold, clinical, and technical profession it had become in the middle of the 20^th Century thanks to its immense science-powered successes.

    Engel argued that the dominant biomedical model inappropriately reduced too many complex health concerns to biology and pathology alone (reductionist), excessively separated body and mind (dualist), and left “no room within its framework for the social, psychological, and behavioral dimensions of illness.” In short, he believed medicine had become dehumanizing, excluding the patient and their “…attributes as a person, a human being.”

    Engel proposed that the BPS model could provide a “…blueprint for research, a framework for teaching, and a design for action in the real world of health care.”

    Ever since publication of this landmark paper, the BPS model has been extensively interpreted and misinterpreted, used and abused and co-opted and perverted. Cormack et al. describe many of the problems that emerged over the years, and I explored that topic in detail, see: BPS-ing badly! How the biopsychosocial model fails pain patients.

23. O’Keeffe M, Purtill H, Kennedy N, et al. Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis. J Pain. 2016 07;17(7):755–74. PubMed 26844416 ❐ PainSci Bibliography 53115 ❐
24. Kent P, Haines T, O'Sullivan P, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. Lancet. 2023 May. PubMed 37146623 ❐ PainSci Bibliography 51276 ❐
25. Ben Cormack, Peter Stilwell, Sabrina Coninx, Jo Gibson. The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiotherapy Theory and Practice. 2022:1–16. PubMed 35645164 ❐ PainSci Bibliography 52047 ❐

    This thoughtful paper argues that Engel’s biopsychosocial model (“an important framework for musculoskeletal research and practice”) has been misapplied in 3 ways:

    1. biomedicalization — just paying lip service to humanism & holism, but still being really rather biomedical
    2. fragmentation — tendency to perceive patients' complaints as this or that (e.g. bio or psycho or social), instead of this AND that (it’s always all of the above)
    3. neuromania — it’s ALL about the 🧠!

    Result? “Suboptimal musculoskeletal care,” in the opinion of the authors.

    I explore this paper and topic in much more detail in BPS-ing badly! How the biopsychosocial model fails pain patients.