Dr. Richard McIlmoyle BSc, DC, PgCPain
BPS and teenage sex!!
Using a Biopsychosocial framework
Nobody really knows how to do it,
Everyone thinks everyone else is doing it,
So everyone claims to be doing it.”
Pete Moore, via Ben Cormack
Understanding the BPS framework in pain management requires an acceptance that the person you are interacting with brings to the table all of the thoughts, beliefs, fears and anxieties that are unique to them. This ecosystem that sits before you is a human who has biological and psychological uniqueness bathed in the social construct in which they have grown up in and are currently immersed.
We MUST understand that the Bio, Psycho, and Social are not separate entities, but components of the whole. Like the ingredients in a cake, the flour, butter and sugar can be can be identified as important components of the cake, but once they combine to make the cake, they cannot be removed and examined separately. OR we can imagine an ecosystem, where the air, water and plants are inextricably intertwined to be a web of interactions, water levels effect the plant growth which effects the levels of moisture and oxygen in the air…etc…etc…
There are obvious examples regarding thoughts/emotions leading to changes in physiology or posture that most people understand. For example, being scared increases your heart rate, or your muscles will stiffen up when frightened.
We can also see a postural expression of emotion, standing tall with shoulders back and face up
slumped shoulders and bowed head.
Or, one of my favourite examples that happens when fans or players lean their body as they are hoping a ball soaring in the air goes through the upright or goes fair/foul. Our emotions, thoughts, physiology, muscle activity and movement patterns are all intimately intertwined. (This concept can be captured in the theoretical construct known as embodied cognition.)
Understanding that the biopsychosocial framework is less of a model of prediction than a conceptual framework to understand human experiences. It is a lens through which we can view our patient experiences to try and help understand what is happening. All sorts of different experiences can be viewed through this lens, not just pain. Learning for example, is optimized when we are well rested, fed, not under duress, and in a supported environment. Another example is athletic training or performance. All of the same criteria are ingredients for optimizing performance and/or training in sport. Understanding that patient experiences are multilayered. Influenced by their past life events, beliefs, current environment, expectations and views of you, their therapist, are all components that become clearer and seem more relevant when viewing people through the biopsychosocial lens. There are detractors who feel that the framework is inadequate, but I believe it is a solid concept to help guide us forward until something better can be developed. Stilwell, P., & Harman, K. (2019). An enactive approach to pain: beyond the biopsychosocial model. Phenomenology and the Cognitive Sciences, 18(4), 637–665. https://doi.org/10.1007/s11097-019-09624-7
Review, F., & Anderson, M. L. (1984). 40) ELSGMLTM(ARTINT):m1a v 1.155 Prn: appeared just since 1995 include, 35(1), 125. https://doi.org/10.1016/S0004-3702(03)00054-7