ADVERTORIAL
Biopsychosocial approach to pain care
By Wendy McLean | BHSc ( Naturopathy ), BAdvSc ( Hons ), PhD
Chronic pain is a significant therapeutic challenge and a rapidly growing public health epidemic that places a burden on the individual and society as a whole . One in five Australians suffer from chronic pain , and pain is the most common reason patients seek medical care . 1 Furthermore , chronic and recurrent pain is highly prevalent in children and adolescents , with several psychosocial variables found to predict pain prevalence in this population . 2
Historically the concept of pain was based on a relationship between an identifiable organic pathology and patient-reported symptoms , and conventional medicine approaches to pain management largely centred on anti-inflammatory and analgesic medications and physical therapy . 3 It is now recognised that chronic pain is a complex sensory and emotional experience that varies widely between individuals , and thus requires an individualised and multimodality approach to treatment . 3 , 4
Biopsychosocial model of pain
According to the biopsychosocial model , pain originates in the nervous system in response to a physiologic stimulus , but an individual ’ s pain experience depends on a complex interaction between various biological , environmental , psychological , and societal factors that reciprocally influence one another . 3 Cognitive and emotional factors have a key influence on pain perception due to connectivity of brain regions which are responsible for processing pain perception , the emotional response to pain , and attention or expectation . 4 Neuroimaging studies have demonstrated that pain pathways are altered by positive and negative emotions , and other factors unrelated to the pain stimulus . 4 This complex interplay may help to explain why patients with long-term chronic pain develop co-morbid anxiety and depression , and also why those with psychological distress , including childhood abuse or trauma , low educational attainment , socioeconomic stress and social isolation , are at an increased risk for chronic pain and central amplification of pain . Furthermore , an individual ’ s beliefs , coping skills , behavioural adaptation and social support can dramatically alter their pain experience . 3 , 4
Chronic pain and mood disorders
Depression and pain co-exist in up to an estimated 80 % of patients , and are associated with impaired health-related quality of life . 5 Observational research indicates that there is a bidirectional link between mood disorders and chronic pain ; and while the presence of a pain condition increases vulnerability to an affective disorder , the pre-morbid presence of depression , anxiety and distress are strong predictors of the transition from acute to chronic pain . 6 Furthermore , the majority of patients who suffer from comorbid depression and pain are non-responsive to pharmacological treatments , 5 and symptoms of depression , anxiety and emotional distress are associated with poorer outcomes in pain patients , including increased physical disability , 7 work disability , healthcare costs , 8 mortality 9 and suicide . 10 Accumulating evidence indicates that depression and pain share clinical manifestations , as well as neuro-biological pathways , neurotrophic factors , hormones and stressors , which has implications for the development and treatment of both simultaneously . 11
Holistic pain management
Treatment of chronic pain requires a multidisciplinary approach that incorporates pharmacological , physical , neuromodulatory , and psychological methods of treatment . In addition , emerging care services that tailor care to the individual person with pain demonstrate superior clinical outcomes . 12 Natural medicine practitioners are in an ideal position to help patients with chronic pain , as individual treatment is an overarching philosophy of most complementary medicine modalities .
* References available on request
If you are seeking to broaden your understanding of effective , holistic clinical strategies for pain management , see our webinar series The World of Pain ; A biopsychosocial framework for holistic practitioners . View more information and purchase the series at www . biomedica . com . au / previous-events
Disclaimer : The views and opinions expressed in these advertorials are those of the authors and do not necessarily reflect the opinions of ATMS or its Directors .
JATMS | Autumn 2022 | 55