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I'm pretty into the biopsychosocial model of pain

We all know and have experienced what pain is, with an exception of those with congenital insensitivity to pain (i.e., being born without the ability to feel pain) (the number of people who have this condition is estimated at 1 in a million, though only about 20 cases are in the scientific literature). I am going to go out on a limb and say, although it can serve great utility in our lives…it sucks. Pain sucks. So, naturally, many people want to get rid of it. But it unfortunately isn’t as easy as we want it to be, with most people being unsatisfied with their pain treatment.

Why? Why would so many people be unsatisfied?

Because pain is complex. The experience of it is influenced by many different factors. Even more complex is trying to explain it to someone. Even if you did explain everything as objectively as

possible, it still may not be good enough. That is because the other person listening still needs to…well listen. And I am not confident people do this well enough. We know we aren't perfectly objective at communicating pain though (which isn’t your fault either).

Ok, so we are imperfect. Do we just call it a day and suffer? NO! We can do things about this. Below I’ll lay out how we can think of pain and pain communication, which I think will lead to understanding within yourself about it and hopefully that will lead to better interactions about pain.

In the past decade or so, pain has taken on an improved vantage point. For the most part, we have moved from a purely biological/biomedical basis of pain to a biopsychosocial basis for the full pain experience. What does this mean?

If we stuck to biological, that would mean we would HAVE to be able to see the pain somewhere explicitly in your body and know the physical cause for it. But, we know that just isn’t true to life. There are so many times we have pain that is seemingly inexplicable. But, within the biopsychosocial

model, there are certainly explanations. This is all talked about more in our write-up for this week. Briefly, the biopsychosocial model of pain just says that the pain experience is due to biological, psychological, and social factors (there is pain in our bodies, our minds/emotions/prior experiences change the perception of that pain, and the people in our lives also inform our perception of pain). Instead, let me use this space to walk through examples around pain communication.

Honestly, this is the stuff that needs to and should be taught in school. It's unfair. Medical doctors are taught how to listen and respond to patients. Yet, patients are not taught how to talk and respond to doctors, how to handle medical visits, and how to advocate for ourselves – YOU are the expert of your body and experience even if medical doctors have the technical expertise about human bodies in general. It's a power imbalance that can and does get exploited.

Doctors are still human and have biases, their own perceptions, and can make mistakes, have leaps in logic, and make assumptions. This obviously does not excuse any of the atrocious misunderstandings and potential prejudices that doctors have, but it does happen (and there needs to be more training on this). There is more I want to say on this idea, but I’ll do so in future blog posts (particularly about women's and the POC experience in doctors’ offices).

There is more to life than doctors however. If you are feeling pain, who do you tell first? Maybe family members. Maybe a significant other. I typically tell a good friend. Luckily he is super understanding of it. He responds appropriately – not too dramatic, but also doesn’t cast it aside. He also helps with the decision of if this seems serious enough for a professional to see as well. This all helps with the pain experience. It helps me feel in control of my pain even if it doesn’t actually change its duration and intensity, at least not directly.

But, let’s say you don’t have a friend like mine. Let’s say you are constantly having to fight to be heard, that your pain is real, that it has been existing for longer than it should, that it really takes away from your ability to concentrate on normal, everyday tasks. How draining it would be to explain yourself and then be told, you’re crazy/stop complaining/it’s made up/I’ve never experienced that so it must not be real? What a different pain experience that is.

I have also had this sort of experience with my chronic headaches and migraines. I do a good job tracking what I eat, when I have the headaches, what else is happening, my stress levels, water intake, sleep, etc. And then by various people I talk to, including doctors, they are just like, deal with it or, it’s common, or have you tried doing x, y, z (spoiler alert: I have). And I end up leaving those situations like, maybe it is just all in my head (no pun intended). For the past 20 years of my life, however, I have been coping with this condition that doctors have no real interest in helping with.

I do think with a focus on this biopsychosocial model, doctors have less of a choice to not treat patients as whole individuals and not just as conditions, disorders, diseases, or other physical ailments. Likewise, we have little choice in treating ourselves like whole, fully respectable people. This is just my thought. Obviously, we aren’t quite there yet. But we are trying.

Maybe some are trying more than others, but we are trying. Just think, though, how much pain in the world could be reduced if we did something more like biopsychosocial model compared to the more biological approach we currently take. People wouldn't have to go to the doctor as often, use medication as often or would use it for a shorter period, drug overdoses would highly decrease, and so much more. It won't solve all of the world's problems, but it would definitely make a dent.


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