Twenty-five years with the biopsychosocial model of low back pain—is it time to celebrate? A report from the twelfth international forum for primary care research on low back pain. (2013)

From the review:

“The biopsychosocial model of back pain has become a dominant model in the conceptualization of the etiology and prognosis of back pain, and has led to the development and testing of many interventions. Despite this, back pain remains a leading source of disability worldwide.”

“Although there is good evidence for the role of biological, psychological, and social factors in the etiology and prognosis of back pain, synthesis of the 3 in research and clinical practice has been suboptimal.”

“Nevertheless results from trials testing interventions aimed at changing psychological factors have been disappointing, and findings from systematic review of psychological interventions for chronic pain groups show the effects are modest at best.”

“In taking stock of the current state of knowledge, it seems evident that vast gaps remain in our understanding about the etiology, prognosis, and effective interventions in back pain despite the biopsychological model. In our view, the biopsychosocial model has not failed to explain back pain, what has failed is the mostly restrictive way it has been understood and applied.” [emphasis added]

My comments:

Or maybe the model has failed to explain back pain, and practitioners continued defense of interventions is just post hoc rationalization for psychological techniques that don’t matter.

This paper was my first introduction to the “biopsychosocial” model of low back pain that was started with Gordon Waddell’s 1987 paper. I actually thought Gordon’s paper was great for the time and when I read it, and I recall few initial objections. However it seems to me that his concept has been taken too far—with followers who want to overemphasize psychological components of pain having to ignore a great deal of subsequent physiological findings with regards to the causes of spinal degeneration, how those causes can be avoided and what exercises do in fact stabilize the spine. Subsequently many practitioners are treating low back pain as primarily a psychological issue, and telling them to continue to work with little in the way of tools to help them avoid further pain. Now after 25 years of doing so, they are having to deal with the fact that their hypothesis (though containing degrees of truth) is not helping  patients lessen low back pain and disability.