A Review of the Common Factors Model and Its Application in Pain Management

Abstract

Pain management providers in the field tend to be eclectic and flexible in their choice of modalities and attempt different treatments until they find something that suits the patient, a phenomenon known as the "Goldilocks effect" which derives from the children's story The Story of the Three Bears. Research studies in pain management have concluded that the diverse treatment interventions currently available all appear to be equivocally effective. In the past, the practice of psychotherapy confronted a similar issue--research studies concluded that all psychotherapies were effective which led to a verdict later termed the "Dodo bird effect" referencing a scene from Alice's Adventures in Wonderland. This conclusion led to the distinction of two possible mechanisms of psychotherapeutic change, specific versus non-specific effects, also known as "common factors." The purpose of the current review is to outline the applicability of the common factors model to pain management and provide supportive evidence from existing research.

Musculoskeletal Faculty Beliefs about the Therapeutic Relationship

“…Their knowledge was a direct result of the evidence that has emerged about specific treatments' influence on outcomes being equivocal for MSK pain. 1,51,58,59 They were also a result of the evidence about the science of pain, which directly challenges the pathoanatomical model. 5,50 This exemplified how a teacher's knowledge of the content can become a belief if there is objective evidence supporting its efficacy.…”

“…This interpersonal dynamic is an essential contextual factor found to positively impact outcomes in many healthcare settings, including physical therapy for the treatment of MSK pain. 1,[13][14][15] To date, Bordin's 16 conceptual framework is the most widely accepted and utilized for the TR, including in physical therapy. 17 However, as contextual factors such as the TR have emerged as instrumental to the successful treatment of MSK pain, several authors have questioned whether the elements proposed by Bordin 16 are sufficient for the physical therapy encounter.…”

“…Enhanced communication and interpersonal skills allow the therapist to develop a positive therapeutic relationship (TR) with the patient, leading to larger treatment effect sizes and more significant positive outcomes. 1,2 Unfortunately, the literature indicates that physical therapists are not fully competent in these skills and some cases, unaware of their importance when treating the MSK pain patient population. 3,4 Many, if not most MSK providers, still hold a biomedical perspective to patient care, so being effective with these skills or recognizing their importance may not be appreciated.…”

Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study

“…Persistent LBP negatively impacts patients’ quality of life, activity levels, ability to work, and earning potential [ 27 ] creating deleterious personal, social, and economic consequences [ 29 – 31 ]. Existing chronic LBP (cLBP) treatments are inadequate [ 32 ], and those focusing on symptom management typically provide modest relief [ 31 , 33 , 34 ]. Consequently, multimodal cLBP management strategies incorporating the biopsychosocial perspective are required [ 32 ].…”