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Understanding Chronic Pain: The biopsychosocial model (version anglaise)

2019/12/09 Accueil Éducation et conseils

Understanding Chronic Pain: The biopsychosocial model (version anglaise)

Pain is the body telling you something is wrong and requires you to do something about it. There are two types of pain: acute and chronic pain.  

Acute pain occurs in the early phase of your injury. It will dissipate once the problem is solved and will improve roughly between 75-80% within 4-12 weeks of your injury. 

Chronic pain is characterized by persisting symptoms that do not change in intensity, is constant and interferes with your daily activities past its due date. Chronic pain sufferers require ongoing monitoring, treatment and multiple approaches to managing the pain. 

Dr. Greg Lehman, a physiotherapist, chiropractor and strength and conditioning specialist treating musculoskeletal disorders within a biopsychosocial model, defines pain as “A distressing experience associated with actual or perceived tissue damage with sensory, emotional and cognitive and social components”. In his book “Recovery Strategies: Your pain workbook” the author underlines the most common misconception that with pain there must be damage. Damage to a musculoskeletal structure does not necessarily mean there will be pain. There can be damage to a tissue with lots of pain or no pain at all or no damage at all and lots of pain. The first steps are understanding why and how.

The idea of the biopsychosocial model, developed in the 1980s, evaluates a person as a whole to understand that the body and the mind is interconnected and can recognize that biology, psychology and social aspects of one’s self are components of pain and illness. 

Biologically, the body has a way to detect and disassociate pain from no pain. Each tissue in our body has an alarm system known as nociceptors. They’re responsible to detect and transmit any potential damage to the spinal cord via the nerves. The brain will receive the message only if the spinal chord decides it’s a potential threat to then get the limb to react (E.g hand on a burning oven). When there is a break in that system pain persists longer then it is necessary, usually constant and will never get to 0/10 on the pain scale because the body is in the protective phase. In the protective phase the nociceptors are on high alert and even more sensitive to perceiving “pain” without any actual physiological injury. If the system is on high alert and uber sensitive perception of pain tends to travel and go to other parts of the body. Pain at this point is no longer local but has spread. This can be influenced by previous injuries and their sensitivities and associated psychosocial factors. 

Essentially, we therefore can manage whether we want to ultimately turn up or turn down the intensity of our pain because pain in not a conscious decision. Lehman suggests to identify the things that contribute to our sensitivity will help patients manage and recover from unexplained long-lasting pain.  

The two other approaches in the biopsychosocial model of pain are the psychological and social factors. 

Emotional factors, lifestyle/health/social factors, beliefs (about pain, attitudes), coping strategies (goal setting), physical habits and impairments, tissue injury all play a role in pain management and desensitization to complete recover in rehabilitation.

You might have heard your physical therapist ask you “Is the pain tolerable?”. The body goes through a habituation phase, in other words, it can tolerate more and more activity or load with very little pain or less pain. Because pain doesn’t necessarily mean damage, in rehabilitation we aim to re-educate and stress the tissues appropriately to tolerate and adapt to greater demand for optimal function. This is where exercise should progress in intensity and to understand that flare-ups and discomforts are normal because the nociceptors will still be on high alert for potential damage but overtime there will be a change in perception and an increase in tolerance.

Rehabilitation is measuring what patients can do independently. Be patient and focus on the progress not the loss and remember that rest is rarely the answer to your pain. Break the cycle and do not fear new stressors because your body will adapt and become resilient to pain. Do not hesitate to ask your health care professional what is appropriate for you.  

 

Annie Choquette, Thérapeute en réadaptation physique
Kinatex Sports Physio Complexe Desjardins

Références

Recovery Strategies: Pain guidebook. Author: Greg Lehman
https://static1.squarespace.com/static/57260f1fd51cd4d1168668ab/t/590dca266b8f5b01a7f97ceb/1494075961206/recovery+strategies+pain+guidebook+2017.pdf

The Biopsychosocial model of assessment prevention and treatment of chronic pain. 
https://touchneurology.com/the-biopsychosocial-model-of-the-assessment-prevention-and-treatment-of-chronic-pain/

Ten Principles of conservative diagnosis
http://www.patientsafetyresearch.org/Schiff_Ten_Principles_Conservative_Diagnosis.pdf

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