Biopsychosocial Model of Low Back Pain Management
Low back pain is the leading cause of years lived with disability around the world. It is so common that it is thought that it should be considered as common-place as the common cold. Those that experience low back pain for more than 3 months, i.e. a chronic problem, commonly also demonstrate signs or anxiety and even depression. That is why there is a now a multi-disciplinary approach to treating low back pain, called the biopsychosocial (BPS) model of treatment. This recognises that the biological, mechanical approach to management is too simplistic to be helpful.
The BPS model involves a combination of physical, psychological, educational and/or work related components to address all aspects of the condition by a team of various professionals. It recognises that the person who is experiencing the problem is not just a set of physical signs and symptoms. Being a human being there are all sorts of emotions that go with the problem as well as influences from work, family and friends that all come together to create an issue that can appear to be a Gordian knot to many practitioners.
In research by Garcia AN, Saragiotto BT (Multidisciplinary biopsychosocial rehabilitation for chronic low back pain (PEDro synthesis) British Journal of Sports Medicine 2016;50:251-252) it was found that this multidisciplinary approach was more effective that usual care and physical treatments, to improve pain and disability in those suffering with chronic low back pain. For work outcomes, the approach appears to be more effective than physical treatment alone.
This, in its most basic terms, does mean that the pain being experienced is as much in the patient’s head as it is physically in the body. In fact all pain is in the head, since it is the brain that interprets the signals coming from the area that appears to be dysfunctioning. The approach to care is to manage the fear of the pain, the fear of more pain as well as attend to the local area where the pain is being experienced. A good practitioner will identify that chronic low back pain cannot be truly resolved in the longterm by one person and should suggest to the patient that a multidisciplinary approach as mentioned above, is the most effect way of managing the person with the condition.