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The Biopsychosocial Model and Clearing

The Clearing Team
The Clearing Team

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Here’s a question: is clinical care for chronic pain mostly about taking vital signs, measuring pain levels and writing prescriptions for medication, or does it need to include a broader perspective than that?

It wasn’t that long ago that clinicians were taught to approach medical care as a set of measurements and relatively brief conversations taking place in a doctor’s office. We’ve all been through the process: get weighed, feel the compression of the blood pressure cuff, stick out our tongues for the thermometer, gaze into the eye exam light, hold out our arms for blood draws, take deep breaths under the stethoscope, and try to explain to medical professionals, very quickly, what seems wrong, then take any resulting prescriptions to the pharmacy to be filled.

These clinical measurements and interactions are very useful. What about all the other things that don’t typically get measured or discussed in the clinic, though? Things like daily stress, what your parents, friends or children are dealing with, even things like how your commute or your daily chores impact you. 

The background of the biopsychosocial model

In 1977, a doctor named George Engel proposed an alternate way of approaching clinical care, which many psychologists, pain specialists and other health providers are now following as a different, more comprehensive way of diagnosing and treating their patients. 

Engel’s approach, which he called the biopsychosocial model, suggested a wider frame of reference for diagnosing and treating patients than the previous process. Within the former approach, clinicians tended to view injuries and diseases as conditions arising from strictly biological causes. They might ascribe back pain, for example, to nerve issues, a slipped disc, strained muscles or arthritis

That approach did give clinicians guidance and encouraged them to seek the root causes for their patients’ conditions. What it didn’t do as well was help specialists understand why two people with apparently similar back aches, for example, could report very different experiences with pain and quality of life.

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How the biopsychosocial model is different

The biopsychosocial approach differs because it broadens the context in which a provider considers a patient’s unique situation. While the approach retains an emphasis on biological causes, it adds psychological and social considerations as well. 

Using this framework, a clinician can expand the potential areas to explore and discuss with the patient while finding a diagnosis and recommending the ideal treatment. A patient with a backache who has a very stressful job, who is worried about their teenager and who experiences severe anxiety might suffer from more severe symptoms than a patient with a similar back ache, but who has a much less stressful job, no serious anxiety, and close relationships that are more supportive and comforting. 

Adding the psychological and social dimensions to their diagnostic approach helps doctors see the potential differences between these two patients and proceed accordingly. While both patients might receive prescriptions for compounded pain cream and might be given a set of tailored exercises to perform, the first patient might receive additional support from a therapist or be encouraged to practice certain stress management techniques as well. 

Since people are in very different situations and have different psychological make-ups and degrees of support and closeness from friends and family, it’s reasonable to treat them differently in the clinic. This makes sense particularly because a patient’s chronic pain is nuanced, complicated and often affected by many different factors. Many of the systems in the brain that handle pain interpretation and signaling, for example, also manage moods and mental functioning, so pain experiences often have both mental and physical components.

Clearing espouses the biopsychosocial approach as a way to look at each person holistically, taking into account everything going on in their lives, not only their pain. No approach is perfect or guaranteed to be an exact fit when it comes to chronic pain, but the biopsychosocial approach gives Clearing's pain specialists more tools to understand what patients are going through and what might be best for each individual person.

This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.