The classic 1977 paper by Engel that introduced the now famous biopsychosocial model of healthcare
Two articles on PainSci cite Engel 1977: 1. Your Back Is Not Out of Alignment 2. What Works for Pain?
BPS in a nutshell: treat patients like (complicated) people.
PainSci commentary on Engel 1977: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
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 20th 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.
~ Paul Ingraham
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.
The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
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:
- 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.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.