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The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the modern biopsychosocial model. Additionally, functional restoration and other early interdisciplinary intervention programs will be highlighted for their importance and effectiveness in chronic pain management, assessment, and prevention.

Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation.

Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older-adult populations suffer a high prevalence of this continually painful state, and further face a unique set of challenges to manage short-and long-term biopsychosocial functioning. As the population ages, and the proportion of older adults grow, it is essential to explore and develop the most effective interdisciplinary strategies to care for older adults who are chronic pain sufferers. In this Commentary, we highlight some of the special challenges that the older-adult population encounters, and their influence on pain management strategies.Keywords: Low back pain; Chronic pain; Biopsychosocial; America; Older adults CommentaryChronic low back pain (CLBP) is a widely prevalent condition affecting more than 25 million Americans [1]. In a recent 2014 report by the National Health Interview Survey (NHIS), it was noted that low back pain was the most prevalent reported pain site, exceeding joint conditions, headache/migraines, neck, and facial, or jaw pain [2]. Roughly one third (34%) of adults aged 65-74, and adults aged 75 and over (34.9%), reported low back pain in the last 3-months [2]. As the population ages, CLBP reports are expected to rise, further necessitating the need to develop interdisciplinary pain management strategies for this growing part of the population [3].In addition to CLBP, older adult populations often have multiple conditions that can complicate and limit traditional pain management therapies. As a result, they face distinctive challenges regarding healthcare regimens, including adherence, physical ability, psychological and social conditions, age-related mental decline, agerelated physical decline, and pharmacological intake concerns. Furthermore, general physical decline due to aging often limits the patient's ability to participate in physical interventions, such as exercise and more vigorous physical therapies. Often, simple stretching techniques or light exercise may not be a viable option [4]. Additionally, psychosocial status must be evaluated for adherence and well-being. Chronic pain patients often experience depression, anxiety, and sleep disorders [5], as well as dementia, Alzheimer's, and other ailments that can impede proper care.Medications are widely prescribed to help combat pain, particularly when these physical limitations are present. On average, older Americans consume multiple medications daily [6]. The large volume of prescription medication consumption certainly influences the available and appropriate treatment options to both avoid side-effects and maintain good quality-of-life. Considering these astonishing figures, it is vital to develop comprehensive, interdisciplinary preventive measures and pain management strategies in order to account for the unique concerns of the older-adult population. This Commentary aims to highlight some of the special challenges the older-adult population faces, and the importance of implementing interdisciplinary treatment strate...

A recent literature review concluded that the comorbidity of chronic pain and depression in adults is approximately 50%-65%. Physical and cognitive declines, concurrent multiple health conditions, and complex medication regimens add to the unique and complex challenges of effectively treating pain in particularly geriatric populations. Interdisciplinary medical intervention and monitoring for psychiatric sequelae, such as depression, cognitive change, and synergistic physical side effects are necessary. Areas covered: This review covers an extensive multi-database wide search of the pharmacotherapy of pain and depression in older adults, including biopsychosocial approaches. One of these, on which this review focuses, is Functional Restoration, an interdisciplinary application of quantified physical rehabilitation, case management, and cognitive behavioral and educational therapies to achieve improved well- being and better physical functioning. The biopsychosocial model incorporates an overview of the overlapping and interactive dimensions of a patient's life and addresses them within a comprehensive plan of treatment. Expert commentary: A multifactorial, rather than a single factor approach to the treatment of complicated health care problems such as chronic pain in an elderly patient is emphasized as an important change in perspective for the health care provider.