Towards an ethical multiplicity in low back pain care: Practising beyond the biopsychosocial model

Abstract

The biopsychosocial model is currently considered by most researchers and clinicians to be the best approach to low back pain (LBP) care. The model was popularised in LBP care in response to some clear deficiencies in earlier biomedical approaches and is now widely recommended in clinical guidelines and policy statements. Yet the biopsychosocial approach has also been critiqued for its narrow conceptualisation and application. In this article, we explore how attending to the multidimensionality of LBP in practice goes beyond a biopsychosocial approach. We engaged with 90 ethnographic observations of clinical practices, 22 collaborative dialogues with clinicians, and eight consultatory meetings with people with experience of LBP to consider the sociomaterialities of clinical practices in two settings: a private physiotherapy practice and a public multidisciplinary pain clinic. Drawing on the work of Annemarie Mol and Rosi Braidotti, our analyses suggest that sociomaterial practices, involving human and non-human actors, produced multiple objects of clinical attention and ethical concerns about how to attend to this multiplicity well. We argue that the multiplicity of LBP is attended well by reimagining: (1) clinical

An exploration of low back pain beliefs held by health care professionals in Northern America

“…Prior data demonstrated a similar gap in understanding in NA general population beliefs in which only a single participant discussed the effects of depression on their pain experience (Ray et al., 2022). Although patients have a role in their own management, this sort of clinician‐blaming minimises the importance of other variables, such as the environment and sociocultural influences on one's pain experience (Craig et al., 2020; Mescouto et al., 2023; Stilwell & Harman, 2019).…”

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia

“…Both data sets were produced as part of a wider project conducted between April 2019 and June 2021. 5,6,24,25 All 45 clinicians from the two study sites were invited to participate in the dialogues. A total of 29 clinicians provided written consent and participated in the dialogues (seven from Site 1 and 22 from Site 2), a response rate of 64.4%.…”

“…Both data sets were produced as part of a wider project conducted between April 2019 and June 2021. 5,6,24,25…”

“…2 However, the model falls short in incorporating important broader dimensions of care, including ethics, culture, and spirituality, 3 along with institutional power dynamics and socio-cultural considerations. [4][5][6] The neglect of such aspects of care might prevent health care professionals and health services from offering equitable practices that offer just outcomes for all patients.…”

Distress in the care of people with chronic low back pain: insights from an ethnographic study

“…CLBP persists or recurs for many years and is often enigmatic in its origins, pathophysiology, diagnosis, and management ( Costa et al, 2022 ). Pain is a complex inter-relationship of biological, psychological, spiritual, contextual, experiential, social, cultural, material, and other elements ( Mescouto et al, 2023 ). Therefore, particularly in its chronic form, pain challenges traditional biomedical approaches, as it complicates the borders of mind and body, objective and subjective, and physical and emotional ( Borkan, 1993 ).…”