Reality Thinking:
The Biopsychosocial Model

This new model is utilized in all national guidelines for management of back pain and forms a significant departure from the biomedical model which looks for a specific structural cause of back pain.

Examples of structural causes are fractures, inflammatory disease and disc herniation. When no such structural cause can be identified, adherents of the biomedical model often recommend bed rest and the standard medical and surgical treatments.

In contrast, with the biopsychosocial model, over 90% of back pain arises from functional pathology – mechanical problems of the joints and muscles, rather than structural pathology.

Back Pain may also be greatly aggravated by psychosocial factors.

Bio: The causes of back pain in most patients are functional or mechanical pathology.

Psycho: Psychological factors

Social: Factors related to lifestyle, work, and how patients and society have learned to view back pain.

With this model, the basis of management must change from rest to early activity. Rest is inappropriate and harmful.

Adverse effects include slower healing, daily loss of muscle strength, demineralization of bone, decreased physical fitness, increase psychologic distress and depression, and increased difficulty in starting rehabilitation.

Helpful effects of early activity include promotion of bone and muscle strength, improved disc and cartilage nutrition and avoidance of psychological problems