Perspective

Perspectives of implementing the biopsychosocial model to treat chronic musculoskeletal pain in primary health care

Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy and Physical Therapy Post-Graduate Program, Universidade Federal de São Carlos (UFSCar), São Carlos, SP 13565-9052, Brazil

Search for more papers by this author

Richard Eloin Liebano

https://orcid.org/0000-0003-4795-6723

Search for more papers by this author

Mariana Arias Avila

*Author for correspondence: Tel.: +55 16 33519791;

E-mail Address: m.avila@ufscar.br

https://orcid.org/0000-0002-5081-5326

Study Group on Chronic Pain (NEDoC), Department of Physical Therapy, Study Group on Chronic Pain (NEDoC), Universidade Federal de São Carlos (UFSCar), São Carlos, SP 13565-905, Brazil

Search for more papers by this author

Published Online:11 Nov 2020https://doi.org/10.2217/pmt-2020-0024

View article

Abstract

Aim: To propose actions to organize healthcare of people with chronic musculoskeletal pain (CMP) into a biopsychosocial approach. Materials & methods: Narrative overview with the Brazilian Unified Health System as archetype to propose the implementation of a biopsychosocial approach to manage CMP. Results: Healthcare systems often use biomedical model for CMP management, which may explain the increase of demand and costs of CMP management. This is significant in Primary Health Care, where the healthcare professionals have difficulty with evaluating and treating psychosocial factors. Conclusion: The present perspective selected some actions that are part of the common procedures in Brazil’s Primary Health Care and proposed a protocol of amplified care for CMP management in all levels: orientation, health promotion, prevention and rehabilitation.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

1. Wiitavaara B, Fahlström M, Djupsjöbacka M. Prevalence, diagnostics and management of musculoskeletal disorders in primary healthcare in Sweden: an investigation of 2000 randomly selected patient records. J. Eval. Clin. Pract. 23(2), 325–332 (2017).
MedlineGoogle Scholar
2. Blyth FM, March LM, Brnabic AJM, Cousins MJ. Chronic pain and frequent use of healthcare. Pain 111(1–2), 51–58 (2004). • Shows that people with chronic musculoskeletal pain seek more healthcare services.
MedlineGoogle Scholar
3. Darlow B, Fullen BM, Dean S, Hurley DA, David Baxter G, Dowell A. The association between healthcare professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur. J. Pain. 16, 3–17 (2012). •• Shows that healthcare professionals present inadequate beliefs and attitudes on pain, which have a negative impact on patients’ treatment.
Medline CASGoogle Scholar
4. Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S. Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J. Physiother. 63(3), 132–143 (2017).
MedlineGoogle Scholar
5. Vlaeyen JWS, Linton SJ. Are we ‘fear-avoidant’? Pain 124(3), 240–241 (2006).
MedlineGoogle Scholar
6. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann. Intern. Med. 166(7), 514 (2017).
MedlineGoogle Scholar
7. Côté P, Wong JJ, Sutton D et al. Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur. Spine J. 25(7), 2000–2022 (2016).
MedlineGoogle Scholar
8. Farre A, Rapley T. The new old (and old new) medical model: four decades navigating the biomedical and psychosocial understandings of health and illness. Healthcare 5(4), 88 (2017).
Google Scholar
9. Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin. Rehabil. 31(8), 995–1004 (2017).
MedlineGoogle Scholar
10. van Dijk-de Vries A, Moser A, Mertens V-C, van der Linden J, van der Weijden T, van Eijk JTM. The ideal of biopsychosocial chronic care: how to make it real? A qualitative study among Dutch stakeholders. BMC Fam. Pract. 13(1), 14 (2012). •• Highlights the difficulty with implementing the biopsychosocial model on settings that provide care for patients with any chronic disease or dysfunction.
MedlineGoogle Scholar
11. Donner-Banzhoff N. Solving the diagnostic challenge: a patient-centered approach. Ann. Fam. Med. 16(4), 353–358 (2018).
MedlineGoogle Scholar
12. Miaskowski C, Blyth F, Nicosia F et al. A biopsychosocial model of chronic pain for older adults. Pain Med. 21(9), 1793–180 (2020).
MedlineGoogle Scholar
13. Trudel-Fitzgerald C, Chen Y, Singh A, Okereke OI, Kubzansky LD. Psychiatric, psychological, and social determinants of health in the Nurses’ Health Study cohorts. Am. J. Public Health 106(9), 1644–1649 (2016).
MedlineGoogle Scholar
14. Conversano C, Poli A, Ciacchini R, Hitchcott P, Bazzichi L, Gemignani A. A psychoeducational intervention is a treatment for fibromyalgia syndrome. Clin. Exp. Rheumatol. 37(Suppl. 116(1)), 98–104 (2019).
MedlineGoogle Scholar
15. Malfliet A, Kregel J, Coppieters I et al. Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain. JAMA Neurol. 75(7), 808 (2018).
MedlineGoogle Scholar
16. Bodes Pardo G, Lluch Girbés E, Roussel NA, Gallego Izquierdo T, Jiménez Penick V, Pecos Martín D. Pain neurophysiology education and therapeutic exercise for patients with chronic low back pain: a single-blind randomized controlled trial. Arch. Phys. Med. Rehabil. 99(2), 338–347 (2018).
MedlineGoogle Scholar
17. Rondon-Ramos A, Martinez-Calderon J, Diaz-Cerrillo JL et al. Pain neuroscience education plus usual care is more effective than usual care alone to improve self-efficacy beliefs in people with chronic musculoskeletal pain: a non-randomized controlled trial. J. Clin. Med. 9(7), 2195 (2020).
Google Scholar
18. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiother. Theory Pract. 32(5), 332–355 (2016).
MedlineGoogle Scholar
19. Louw A, Puentedura EJ, Zimney K, Cox T, Rico D. The clinical implementation of pain neuroscience education: a survey study. Physiother. Theory Pract. 33(11), 869–879 (2017).
MedlineGoogle Scholar
20. Lane E, Fritz JM, Greene T, Maddox D. The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial. BMC Musculoskelet. Disord. 19(1), 386 (2018).
MedlineGoogle Scholar
21. Pas R, Rheel E, Van Oosterwijck S et al. Pain neuroscience education for children with functional abdominal pain disorders: a randomized comparative pilot study. J. Clin. Med. 9(6), 1797 (2020).
Google Scholar
22. Louw A, Landrus R, Podolak J et al. Behavior change following pain neuroscience education in middle schools: a public health trial. Int. J. Environ. Res. Public Health. 17(12), 4505 (2020).
Google Scholar
23. Pack R, Gilliland R, Mecham A. The treatment of central sensitization in an adolescent using pain neuroscience education and graded exposure to activity: a case report. Physiother. Theory Pract. 36(10), 1164–1174 (2020).
MedlineGoogle Scholar
24. Neto M, Andias R, Silva AG. Pain neuroscience education and exercise for neck pain. Pediatr. Phys. Ther. 30(3), 196–201 (2018).
MedlineGoogle Scholar
25. Malfliet A, Kregel J, Meeus M et al. Patients with chronic spinal pain benefit from pain neuroscience education regardless the self-reported signs of central sensitization: secondary analysis of a randomized controlled multicenter trial. PM R 10(12), 1330–1343.e1 (2018).
MedlineGoogle Scholar
26. Simões P, Andias R, Simões D, Silva AG. Group pain neuroscience education and dance in institutionalized older adults with chronic pain: a case series study. Physiother. Theory Pract. doi: 10.1080/09593985.2020.1728794 (2020) (Epub ahead of print).
MedlineGoogle Scholar
27. Rufa A, Beissner K, Dolphin M. The use of pain neuroscience education in older adults with chronic back and/or lower extremity pain. Physiother. Theory Pract. 35(7), 603–613 (2019).
MedlineGoogle Scholar
28. Reis F, Meziat N, Nogueira L, Louw A, Palermo T, Ickmans K. A journey to learn about pain. (2018). http://pesquisaemdor.com.br/?page_id=84
Google Scholar
29. Moseley L, Butler D. Explain Pain. NoiGroup Publications, Adelaide City, Australia (2013).
Google Scholar
30. Pas R, Meeus M, Malfliet A et al. Development and feasibility testing of a pain neuroscience education program for children with chronic pain: treatment protocol. Brazilian J. Phys. Ther. 22(3), 248–253 (2018).
MedlineGoogle Scholar
31. van Erp RMA, Huijnen IPJ, Köke AJA, Abbink FE, den Hollander M, Smeets RJEM. Development and content of the biopsychosocial primary care intervention ‘Back on Track’ for a subgroup of people with chronic low back pain. Physiotherapy 103(2), 160–166 (2017).
Medline CASGoogle Scholar
32. Moseley LG, Butler DS. Explain Pain Supercharged. NoiGroup Publications, Adelaide City, Australia (2017). •• Book with the theoretical background and the main points to use when applying pain neuroscience education.
Google Scholar
33. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian Health System: history, advances, and challenges. Lancet 377(9779), 1778–1797 (2011). •• Presents information on the Brazilian Health System.
MedlineGoogle Scholar
34. Mendes EV. As Redes de Atenção à Saúde (2nd Edition). Organização Pan-Americana de Saúde, Unidade Técnica de Serviços de Saúde, Brasília,DF, Brazil.
Google Scholar
35. Marcucci FCI, Cabrera MAS, Perilla AB et al. Identification and characteristics of patients with palliative care needs in Brazilian primary care. BMC Palliat. Care 15(1), 51 (2016).
MedlineGoogle Scholar
36. Ministério da Saúde do Brasil. Saúde da Família: uma estratégia para a reorientação do modelo assistencial. World Heal. Organ. 13(4), 44 (1997).
Google Scholar
37. Ministério da Saúde do Brasil. Relatório Final da 10^a Conferência Nacional de Saúde. Presented at: 10th National Health Conference BRASÍLIA, DF, Brazil, 2–6 September 1996.
Google Scholar
38. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLoS ONE 12(6), e0178621 (2017).
MedlineGoogle Scholar
39. Louw A, Puentedura EJ, Zimney K, Schmidt S. Know pain, know gain? A perspective on pain neuroscience education in physical therapy. J. Orthop. Sports Phys. Ther. 46(3), 131–134 (2016).
MedlineGoogle Scholar
40. Nijs J, Van Houdenhove B, Oostendorp RAB. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Man. Ther. 15(2), 135–141 (2010).
MedlineGoogle Scholar
41. Jull G. Biopsychosocial model of disease: 40 years on. Which way is the pendulum swinging? Br. J. Sports Med. 51(16), 1187–1188 (2017).
MedlineGoogle Scholar
42. Zimney K, Louw A, Puentedura EJ. Use of therapeutic neuroscience education to address psychosocial factors associated with acute low back pain: a case report. Physiother. Theory Pract. 30(3), 202–209 (2014).
MedlineGoogle Scholar
43. Gaikwad M, Vanlint S, Moseley GL, Mittinty M, Stocks N. Understanding patient perspectives on management of their chronic pain: online survey protocol. J. Pain Res. 10, 31–35 (2016).
MedlineGoogle Scholar
44. Nijs J, Roussel N, Paul van Wilgen C, Köke A, Smeets R. Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man. Ther. 18(2), 96–102 (2013).
MedlineGoogle Scholar
45. Geneen LJ, Martin DJ, Adams N et al. Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis. Syst. Rev. 4(1), 132 (2015).
MedlineGoogle Scholar
46. Lee H, Moseley GL, Hübscher M et al. Understanding how pain education causes changes in pain and disability: protocol for a causal mediation analysis of the PREVENT trial. J. Physiother. 61(3), 156 (2015).
MedlineGoogle Scholar
47. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch. Phys. Med. Rehabil. 92(12), 2041–2056 (2011). •• Review showing the effects of pain neuroscience education on chronic musculoskeletal pain patients.
MedlineGoogle Scholar
48. de Figueiredo EN. Estratégia Saúde da Família e Núcleo de Apoio à Saúde da Família: diretrizes e fundamentos. Módulo Político Gestor. 5, 49–69 (2010).
Google Scholar
49. Ramos LH. Gestão de Serviços de Saúde. Bras. Ministério da Saúde 14, 195–230 (2011).
Google Scholar
50. Fagundes FRC, Costa LOP, Fuhro FF, Manzoni ACT, de Oliveira NTB, Cabral CMN. Orebro questionnaire: short and long forms of the Brazilian-Portuguese version. Qual. Life Res. 24(11), 2777–2788 (2015).
MedlineGoogle Scholar
51. Pilz B, Vasconcelos RA, Marcondes FB, Lodovichi SS, Mello W, Grossi DB. The Brazilian version of STarT Back Screening Tool: translation, cross-cultural adaptation and reliability. Brazilian J. Phys. Ther. 18(5), 453–461 (2014).
MedlineGoogle Scholar
52. Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A. Easy to harm, hard to heal. Spine (Phila Pa 1976) 40(11), 842–850 (2015).
MedlineGoogle Scholar
53. Turner JA, Dworkin SF. Screening for psychosocial risk factors in patients with chronic orofacial pain. J. Am. Dent. Assoc. 135(8), 1119–1125 (2004).
MedlineGoogle Scholar

Vol. 11, No. 2

Metrics

Downloaded 300 times

History

Received 21 April 2020

Accepted 29 September 2020

Published online 11 November 2020

Published in print March 2021

Information

Keywords

Acknowledgments

Part of this manuscript was presented at the 17th World Congress on Pain, held on 12–16 September 2018 at Boston, MA, USA; title ‘Perspectives of Implementing Pain Neuroscience Education as Therapeutic Intervention for Chronic Musculoskeletal Pain in Primary Health Care’.

Financial & competing interests disclosure

This study was partially financed by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), finance code 001. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

PDF download