Twenty-Five Years With the Biopsychosocial Model of Low Back Pain—Is It Time to Celebrate? A Report From the Twelfth International Forum for Primary Care Research on Low Back Pain

aDepartment of Psychology, Royal Holloway, University of London, England, UK. bResearch Department, Spine Centre of Southern Denmark, Institute of Regional Health Services Research, Hospital Lillebaelt, University of Southern Denmark, Middelfart, Denmark cMusculoskeletal Research Program, Northwestern Health Sciences University, Minnesota, USA dNordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark eDalla Lana School of Public Health, University of Toronto, Toronto, Canada fCanadian Memorial Chiropractic College, Toronto, Canada gLiberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA hDepartment of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester Massachusetts, USA iHarvard School of Public Health, Boston, USA jInstitute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Spine (Impact Factor: 2.3). 08/2013; 38(24). DOI: 10.1097/BRS.0b013e3182a8c5d6
Source: PubMed


Study Design. An integrated review of current knowledge about the biopsychosocial model of back pain for understanding aetiology, prognosis and interventions, as presented at the plenary sessions of theXII International Forum on LBP Research in Primary Care (Denmark 17-19 October 2012).Objective. To evaluate the utility of the model in reference to rising rates of back pain related disability, by identifying a) the most promising avenues for future research in biological, psychological and social approaches, b) promising combinations of all three approaches and c) obstacles to effective implementation of biopsychosocial based research and clinical practice.Summary of Background Data. The biopsychosocial model of back pain has become a dominant model in the conceptualisation of the aetiology and prognosis of back pain, and has led to the development and testing of many interventions. Despite this back pain remains a leading source of disability worldwide.Methods. The review is a synthesis based on the plenary sessions and discussions at the XII International Forum on LBP Research in Primary Care. The presentations included evidence-based reviews of the current state of knowledge in each of the three areas (biological, psychological and social), identification of obstacles to effective implementation and missed opportunities, and identification of the most promising paths for future research.Results. While there is good evidence for the role of biological, psychological and social factors in the aetiology and prognosis of back pain, synthesis of the three in research and clinical practice has been suboptimal.Conclusion. The utility of the biopsychosocial framework cannot be fully assessed until we truly adopt and apply it in research and clinical practice.

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    • "Acute and chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice.15–18 The biopsychosocial framework is seen as increasing the potential for developing better treatments and interventions. "
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    ABSTRACT: Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain), which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for studying local tissue alterations and allows for sampling of substances in the interstitium of the muscle, where nociceptor free nerve endings are found close to the muscle fibers. The extracellular matrix plays a key role in physiologic functions of cells, including the primary afferent nociceptor. The present review mainly concerns the results of microdialysis studies and how they can contribute to the understanding of activated peripheral nociceptive and pain mechanisms in humans with chronic pain. The primary aim was to review molecular studies using microdialysis for the investigation of human chronic muscle pain, ie, chronic masticatory muscle pain, chronic trapezius myalgia, chronic whiplash-associated disorders, and chronic widespread pain/fibromyalgia syndrome. Several studies clearly showed elevated levels of serotonin, glutamate, lactate, and pyruvate in localized chronic myalgias and may be potential biomarkers. These results indicate that peripheral muscle alterations are parts of the activated pain mechanisms in common chronic pain conditions. Muscle alterations have been reported in fibromyalgia syndrome and chronic widespread pain, but more studies are needed before definite conclusions can be drawn. For other substances, results are inconclusive across studies and patient groups.
    Journal of Pain Research 06/2014; 2014:7:313 - 326. DOI:10.2147/JPR.S59144
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    ABSTRACT: Objective This article discusses the need for theoretical foundations in epidemiological research of musculoskeletal conditions and suggests the use of biopsychosocial theory when designing epidemiological studies. The association between smoking and back pain is used as an example. Discussion Theory-driven musculoskeletal epidemiologic research is not common. In the epidemiological study of musculoskeletal conditions, there are multiple potential causes of a disease or disorder. Classic biomedical theory is not well suited to explain such phenomena. Biopsychosocial theory is a means through which investigators might formulate hypotheses for testing relationships between smoking, back pain, and other variables. Various types of conceptual frameworks and analytical models can be informed by biopsychosocial theory. Conclusion Biopsychosocial theory is well suited for public health and epidemiological studies on musculoskeletal conditions, such as the relation between back pain and smoking, and may be useful to address the multivariable inputs for this association. Although it is not a perfect model, it provides theoretical guidance to inform the research question, an element of research design that is lacking in modern-day epidemiologic reports.
    Journal of Chiropractic Humanities 12/2013; 20(1):1–8. DOI:10.1016/j.echu.2013.10.004
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    ABSTRACT: Objectives (1) To identify risk factors for chronic disability in people with acute whiplash associated disorders (WAD). (2) To estimate the impact of the numbers of risk factors present. Design Prospective cohort study. Data were collected, on average, 32 days after injury (SD = 10.9) and 12 months later. Baseline measures of pain, disability, neck movement, psychological and behavioural factors were independent variables and chronic disability at 12 months was the dependent variable in a multivariable logistic regression analysis. Setting National Health Service physiotherapy departments. Participants Participants (n = 599) with symptoms 3 weeks after injury, self-referred to physiotherapy as part of a randomised controlled trial. 430 (72%) participants provided complete data for this analysis. Main outcome measures Chronic disability based on Neck Disability Index scores. Results 136 (30%) participants developed chronic disability. High baseline disability (OR 3.3, 95%CI 1.97 to 5.55), longer predicted recovery time (OR 2.4, 95%CI 1.45 to 3.87), psychological distress (OR 1.9, 95%CI 1.05 to 3.51), passive coping (OR 1.8, 95%CI 1.07 to 2.97) and greater number of symptoms (OR 1.7, 95%CI 1.07 to 2.78) were associated with chronic disability. One risk factor resulted in 3.5 times the risk (95%CI 1.04 to 11.45) of chronic disability but this risk increased to 16 times (95%CI 5.36 to 49.27) in those with four or five risk factors. Conclusion Baseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important. Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD. The number of risk factors present should be considered when evaluating potential for poor outcome.
    Physiotherapy 04/2014; 101(1). DOI:10.1016/ · 1.91 Impact Factor
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