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The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization

PainSci » bibliography » Cormack et al 2022

Five articles on PainSci cite Cormack 2022: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Neck Pain & Cricks3. Your Back Is Not Out of Alignment4. Do Nerve Blocks Work for Neck Pain and Low Back Pain?5. What Works for Pain?

PainSci notes on Cormack 2022:

This opinion 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.

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.

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: