A Biopsychosocial Approach

Using the Biopsychosocial Model to Care for Patients with Chronic Primary Pain of the Spine

Norman W. Kettner, DC (’80), DACBR, FICC, dean of research and professor emeritus of Logan’s Department of Radiology, Timothy Williamson, DC (’19), Chandler Bolles, DC (’19) and Nicholas Hedges, DC (’19) authored a two-part study that aimed to characterize the nature of chronic primary pain of the spine and provide clinicians with a framework for an improved, integrative approach to patient care that adopts concepts from the biopsychosocial model.

Parts 1 and 2 of the study “Chronic Primary Pain of the Spine: An Integrative Perspective” were published in Springer Nature Comprehensive Clinical Medicine in January 2021. Part 1 consists of a review of 112 articles surrounding current models of nonspecific low back and neck pain, especially chronic and disabling pain, including differential diagnosis, risk factors, etiology and pathophysiology.

According to the study, chronic primary pain occurs in one or more anatomic regions, persists or recurs for more than three months, is associated with significant emotional distress or functional disability, and cannot be better explained by another condition. Patients can have a genetic predisposition or exhibit psychological risks, and socioeconomic status and cultural differences can play a significant role.

“Current evidence shows chronic back and neck pain is manifested and perpetuated by myriad factors such as insomnia, poor diet, smoking and depression,” Dr. Kettner said. “This indicates it is essential for clinicians to understand the multidimensional array of biopsychosocial elements that might contribute to a patient’s condition.”

Introduced in 1977 by George Engel, MD, the biopsychosocial model posits that biological, psychological and social factors all play a significant role in health and disease. “By using the biopsychosocial model, clinicians can address not only the biological factors, but the psychological and social components to effectively treat chronic primary pain of the spine,” Dr. Kettner said.

Part 2 of the study draws from 136 articles to discuss the current management of chronic primary pain of the spine and presents ways clinicians can use the biopsychosocial model to improve patient care.

It begins by analyzing the current state of spine care, including the use of invasive surgeries and opioid prescriptions that have proven to be ineffective and unsafe and that only focus on biological components. “Clinicians who treat patients using a biomedical reductionist approach are studying trees and failing to appreciate the forest,” Dr. Kettner said. “Psychosocial interventions play a dominant role in the management of chronic pain of the spine.”

In alignment with the biopsychosocial

Dr. Norman W. Kettner model, Dr. Kettner and his co-authors call for an integrative approach that minimizes intervention and maximizes results by attempting to induce a change in the pain- and health-related behaviors of patients with chronic primary spine pain. They advocate for providing treatment using a personalized plan consisting of various interventions including psychological approaches, adjunctive manual therapies, and coaching patients through self-care strategies such as rehabilitative exercises or relaxation-based methods.

“Every patient has a unique and subjective chronic pain experience, so an individualized care plan must be administered, “Dr. Kettner said. “Clinicians should identify interventions that best suit their patient’s needs to optimize compliance, effectiveness, satisfaction and quality of life.”

Scan the QR codes below to read Part 1 (left) and Part 2 (right) of the study.

“By using the biopsychosocial model, clinicians can address not only the biological factors, but the psychological and social components to effectively treat chronic primary pain of the spine.” – Dr. Norman W. Kettner “Every patient has a unique and subjective chronic pain experience, so an individualized care plan must be administered. Clinicians should identify interventions that best suit their patient’s needs to optimize compliance, effectiveness, satisfaction and quality of life.” – Dr. Norman W. Kettner