The biopsychosocial model of pain 40 years on: time for a reappraisal?

Nicholas, Michael K.

doi:10.1097/j.pain.0000000000002654

Cited by 46 publications

(27 citation statements)

References 159 publications

(291 reference statements)

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“…Recent research suggests that understanding the influence of psychosocial factors on patients' experiences may account for some of this discordance [14,25]. Historically, a biomedical model of care has been used to guide the treatment of patients with knee OA, with a predominant focus on pathologic findings [47]. However, pathologic processes cannot account for individual differences in each patient's general makeup or social and environmental influences; because of this, perhaps there is a great deal of unaccounted-for variance in clinical outcomes after procedures such as knee arthroplasty [46].…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population

Yang

Woon

Griva

et al. 2022

Clin Orthop Relat Res

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BackgroundA patient’s experience with knee osteoarthritis (OA) is influenced by many psychosocial contributors that can influence the impact of pain. Such factors are known to explain some of the discordance between objective clinical parameters and patient-reported levels of disability and treatment effectiveness. However, few data are available to help clinicians understand the psychosocial factors that apply to the world’s many Asian populations. Insights gained from a qualitative study in such a population may support targeted interventions.Questions/purposesIn this qualitative study involving a group of Asian patients with knee OA in Singapore, we asked: (1) What psychologic factors contribute to patients’ experiences, rehabilitation, and recovery? (2) What social factors contribute to patients’ experiences, rehabilitation, and recovery?MethodsSemistructured interviews eliciting broad patient experiences of managing knee OA were conducted in an urban, referral-based tertiary hospital in central Singapore. Patients were recruited if they met either of the following criteria: Kellgren-Lawrence grade ≥ 3 (minimum of one knee); Knee Injury and Osteoarthritis Outcome Score ≤ 60; or the Pain average (P), interference with Enjoyment of life (E), and interference with General activity (G) (PEG) ≥ 5. All patients had a clinical diagnosis of knee OA, were ambulatory in the community with or without a walking aid, had not undergone partial arthroplasty or TKA, were prescribed nonsurgical treatment, and were conversant in either English or Mandarin. Forty-six patients (30 women and 16 men, mean age 64 years old) were recruited for this study. A thematic analysis with elements of grounded theory and framework analysis was performed using a deductive approach. Psychologic influences specific to patients’ behavioral and emotional responses to pain, as well as social factors known to have an impact on the experience of managing knee OA, were identified in the interview transcripts and coded according to established factors from earlier research. An inductive thematic analysis was then applied to the remaining transcripts to identify new themes that emerged from the data. Thematic saturation was attained when study team members agreed data and thematic sufficiency were met in the 46 transcripts. The study team discussed and deemed the 46 transcripts to contain sufficient insights for a reasonably clear understanding of the codes and development of themes to answer the study’s research questions.ResultsSix main themes related to psychosocial influences on pain emerged. Psychologic factors were “loss of face” because of knee OA, anticipation and avoidance of pain and suffering, and a vicious cycle of negative emotional experiences. The social factors we identified were social and family support, workplace environment and employment uncertainty, and built environment (patients’ ability to navigate manmade structures and facilities).ConclusionPsychosocial factors have an important impact on patients’ physical, psychologic...

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Section: Introductionmentioning

confidence: 99%

A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population

Yang

Woon

Griva

et al. 2022

Clin Orthop Relat Res

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“…The biopsychosocial model has a long tradition in understanding chronic pain. The so-called onion model, for example, posits a biologic process (“nociception”) wrapped in subsequent layers of perception, affect, behavior, and environmental factors (51). To provide treatment effectively, all layers should be acknowledged and targeted in a multidisciplinary treatment approach.…”

Section: Discussionmentioning

confidence: 99%

Psychological Factors Predict Higher Odds and Impairment of Post-COVID Symptoms: A Prospective Study

et al. 2023

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Objective The causes of the long-term persistence of symptoms after a severe acute respiratory syndrome coronavirus 2 infection (i.e., post-COVID syndrome) remain elusive. Although previous research identified demographic and medical risk factors for the development of post-COVID, the present prospective study is the first to investigate the role of psychological factors. Methods The interview and survey data of polymerase chain reaction–positive participants (n = 137; 70.8% female) were assessed in the acute, subacute (3 months after symptom onset), and chronic phases (6 months after symptom onset) of COVID. Results After controlling for medical (body mass index, disease score) and demographic factors (sex, age), psychosomatic symptom burden (measured by the Somatic Symptom Disorder—B Criteria Scale) predicted higher odds and magnitude of COVID-related symptom impairment in the post-COVID phases. Fear of COVID-related health consequences (measured by the Fear of COVID Scale) also predicted higher odds of reporting any COVID symptoms in the subacute and chronic phases, whereas it only predicted a higher magnitude of COVID-related symptom impairment in the subacute phase. In subsequent exploratory analyses, we found that other psychological factors were associated with an overall increase (i.e., chronic stress and depression) or decrease (i.e., trait positive affect) in the odds and magnitude of COVID-related symptom impairment. Conclusions We conclude that psychological factors can fuel or temper the experience in post-COVID syndrome, opening new possibilities for psychological interventions. Trial Registration The study protocol was preregistered in the Open Science Framework (https://osf.io/k9j7t).

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“…Researchers have recently shown that psychological factors affect the continuity and worsening of pain. 2,3 A person's experience of pain and how to interpret it plays an essential role in the perception of it. The part of this experience is only related to physical factors.…”

Section: Introductionmentioning

confidence: 99%

“…Researchers have recently shown that psychological factors affect the continuity and worsening of pain. 2,3…”

Section: Introductionmentioning

confidence: 99%

Associations between the perception of dental pain and pain anxiety, mental pain, and dental anxiety in Iranian sample

Taheri

Parvizifard

Reisi

et al. 2023

Int J Psychiatry Med

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Objective This study examined the perception of dental pain and its relationship to pain anxiety, dental anxiety, and mental pain. Methods This cross-sectional study was conducted on 328 patients referred to dental clinics in Kermanshah (Iran) from 2020 to 2021. The instruments used in this study included questionnaires about Pain Anxiety, Dental Anxiety, Mental Pain, and Pain Perception. Results There was a significant positive relationship( p = .001) between pain perception with dental anxiety (r = .38), pain anxiety (r = .45), and mental pain (r = .25). Conclusion Psychological factors are associated with the perception of dental pain. Given the importance of dental care to overall health, psychological interventions may help to reduce the perception of dental pain and the fear of seeing the dentist in Iran.

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The biopsychosocial model of pain 40 years on: time for a reappraisal?

Cited by 46 publications

References 159 publications

A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population

A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population

Psychological Factors Predict Higher Odds and Impairment of Post-COVID Symptoms: A Prospective Study

Associations between the perception of dental pain and pain anxiety, mental pain, and dental anxiety in Iranian sample

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