The biopsychosocial model is lost in translation
Seven articles on PainSci cite Cormack 2022: 1. The Complete Guide to Low Back Pain 2. The Complete Guide to Neck Pain & Cricks 3. Your Back Is Not Out of Alignment 4. Do Nerve Blocks Work for Neck Pain and Low Back Pain? 5. Cognitive Behavioural Therapy for Chronic Pain 6. Mind Over Pain 7. What Works for Chronic Pain?
PainSci notes on Cormack 2022:
This thoughtful paper argues that Engel’s biopsychosocial model (“an important framework for musculoskeletal research and practice”) has been misapplied in 3 ways:
- biomedicalization — just paying lip service to humanism & holism, but still being really rather biomedical
- 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)
- 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.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
INTRODUCTION: There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel’s original BPSM. These deviations have led to confusion and suboptimal patient care.
OBJECTIVES: 1) To review Engel’s original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an “enactive” modernization of the BPSM.Methods Critical narrative review in the context of musculoskeletal pain.
RESULTS: The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a “humanistic” interpretation based on person- and relationship-centredness. The second version is a “causation” interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations.
CONCLUSION: The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an “enactive-BPS approach” to musculoskeletal care aligns with Engel’s vision yet addresses theoretical limitations and may mitigate misapplications.
related content
- “The need for a new medical model: a challenge for biomedicine,” Engel, Science, 1977.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.