Interventional Pain Medicine: Retreat from the Biopsychosocial Model of Pain
By Randy S. Roth, PhD; Michael E. Geisser, PhD; and David A. Williams, PhD
(Published online in Translational Behavioral Medicine on November 16, 2011)
The biopsychosocial model (BPSM) serves as a theoretical foundation for the application of multidisciplinary approaches to illness management across many medical conditions. The field of pain management has benefitted greatly from its inclusion within this model
In this review, we will examine the conceptual and clinical issues that reflect the failure of IPM, in its most general form, as an independent pain practice. We will argue that IPM is out of step with both the modern biopsychosocial view of pain and current understandings of basic mechanisms associated with pain processing. We will devote particular attention to the importance of maladaptive pain beliefs and pain coping strategies as powerful moderators of the pain experience. By excluding these variables when considering candidacy for nerve blockade, IPM treatment outcomes are potentially compromised or subverted. We will also consider the impact of a procedurally oriented pain practice on the physician–patient relationship and discuss how the nature of this relationship can inadvertently reinforce maladaptive pain beliefs or undermine effective pain coping strategies being adopted by the patient.
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