Models of Pain Management

There are three models of pain management: the traditional biomedical model, the biopsychosocial model, and the multidimensional model.

The traditional biomedical viewpoint of pain is that a body part is damaged and sends nerve messages of pain (nociception) to the brain, where it is interpreted as noxious. Treatments are geared toward blocking these impulses, usually by medications, e.g., non-steroidal anti-inflammatory drugs (NSAIDs), opiates, anesthetics, etc. or by direct injections of steroids or local anesthetics, etc. However, millions of Americans with chronic pain find their care fragmented among an endless array of specialists and sub-specialists who subdivide organs and multiply therapies. For these patients, an expanded model of understanding pain is needed.

The biopsychosocial (BPS) model of illness was first proposed in the 1960s. Over the last 30 years knowledge gained from stress/illness research and from studies on the psychology of behavior has led to the rise of the behavioral approach to understanding and managing pain. This approach is now accepted by the medical mainstream and as a result, much of modern pain management focuses on rewarding functional gain, ignoring pain behaviors, teaching patients not to focus on the symptom itself and avoiding self-defeating negative thoughts. The specific therapies identified with this approach include cognitive/behavioral psychotherapy and mind/body treatments such as biofeedback, hypnosis and meditation. This approach is also called the rehabilitation model, because the focus is on improved function in daily life rather than on elimination of pain sensations.

A multidimensional model, however, is needed to understand a range of innovative CAM treatments that do not fit into even the BPS model. Treatments such as acupuncture, homeopathy, Reiki/Therapeutic Touch (TT) all require an expanded paradigm that embraces “energy” medicine and spirituality. Because chronic pain involves many factors, it is difficult for a solo practitioner to treat adequately. Multidisciplinary teams and strong referral networks that include this wide range of approaches are now a must in the real work of clinical practice.

Resources

Loder E, Herbert P and McAlary P. Chronic pain rehabilitation, in Ballantyne J (Ed.), Massachusetts General Hospital Handbook of Pain Management, 2nd Ed., Lippincott Williams and Wilkins, Philadelphia, 2002.
Leskowitz, E. Chronic Pain, in Leskowitz, E. (Ed.), Complementary and Alternative Medicine in Rehabilitation, Churchill Livingston, St. Louis, 2002. 5th floor WB 890 L629 2003
Astin J, Mind-body therapies for the management of pain. Clinical Journal of Pain, 20(1):27-32, 2004. Spencer J, Chronic Pain, in Spencer J and Jacobs J (Eds.), Complementary and Alternative Medicine: An Evidence Based Approach, Mosby :St. Louis, 2003 (2nd ed.). Reserve WB 890 C7365 2003

Oschman, J. Energy Medicine: The Scientific Basis, Churchill Livingstone : St. Louis MO, 2000. Reference WB 890 O81e 2000

Dillard, J The Chronic Pain Solution: The Comprehensive, Step-by-Step Guide to Choosing the Best of Alternative and Conventional Medicine, Bantam Press : New York, 2002.