Pain Assessment and Management, 2nd Edition _ _________________________________________________
BIOPSYCHOSOCIAL MODEL Pain is not limited to physical symptoms. There is often an impact on the biopsychosocial components of an individual’s health and life. The biopsychosocial model of health is an interaction between the biological, psychological, and social aspects of an individual. The biological elements are the body’s physical components that shape a person’s health. The psychological elements include the cognitive, emotional, motivational, attitudinal, and behavioral components that influence health. According to Lehman et al. (2017), the social elements are the “actual or perceived social contacts on health” (p. 3). Mescouto et al. (2022) include broader aspects of the social components, including culture, interpersonal, and institutional power dynamics. More recently, there has been a push to increase the focus on the social components in particular. The biological components continue to be the primary focus even with evidence that the social determinants are more indicative of overall health (Haslam et al., 2019). Each element or component influences the overall health of a person over time. This can be seen when an individual experiences pain; the physical limitation may affect the social components of an individual’s life. Over time, the social com- ponents, together with the physical limitations, often influence the psychological dimensions (Lehman et al., 2017). Reviews of the literature by Samoborec et al. (2018) and Mescouto et al. (2022) found that many of the factors that influence recovery were attributed to each component of this model. These studies identify biological and psychological components as consistent factors that influence an individual’s recovery. Mescouto et al. (2022) found that the social compo-
nents are often overlooked and need to be better addressed in the literature. While there is research to support some social factors that can inhibit a person’s recovery, these factors should be addressed cautiously, as there is a need for further research to support this relationship. Factors impacting recovery identi- fied by these authors can be reviewed in Table 2 . Self-Assessment Question 2 2. Which model is best used when working with individuals who experience chronic pain?
A) Biopsychosocial B) Biomechanical C) Holistic D) Occupation based
IMPACT OF PAIN ON PERFORMANCE The impact of pain on an individual’s performance in occu- pations can be all-encompassing. According to the CDC, 23.7 million (43.5 %) adults diagnosed with arthritis limit their participation in activities (CDC, 2022). There have been several studies that identify performance problems for different diagnoses. Wiitavaara and Heiden (2020) identified 16 questionnaires that were often used to assess the physical function of individuals with low back pain. These authors found the Fairbanks et al. (1980) Oswestry Disability Index and the Kopec et al. (1995) Quebec Back Pain Disability Scale to be of good quality to be used to assess the ability to cope with activities of daily life. A number of authors use the Law et al. (1990) Canadian Occupational Performance Measure (COPM) to assess a client’s perception of ability and satisfac-
FACTORS IMPACTING RECOVERY
Biological domain
• Pain, including the type, intensity, and duration • Age • Sex • Pre-accident physical or mental disability/chronic condition (posture/range of motion [ROM])
Psychological domain
• Pain catastrophizing and causal beliefs • Recovery expectations and coping skills
• Posttraumatic stress disorder, anxiety, and depression • Pre-accident health-seeking behavior and somatization • Cognitive factors • Previous unemployment and low educational level • Hospitalization status • Procedural justice and compensation process • Lack of trust by insurers • Importance of timely healthcare decision making • Family and social support • Living situation/environment
Social domain (taken in context with all other factors)
Source: Adapted from Mescouto et al. (2022); Samoborec et al. (2018)
Table 2
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