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Written by

Professor Bart Morlion

Professor Bart Morlion is professor at the University of Leuven and director of the Leuven Centre for Algology & Pain Management at the University Hospitals of Leuven, Belgium.

Slow adoption of the biopsychosocial approach to chronic pain threatens patient quality of life

Published 13 January 2016

Professor Bart Morlion argues that clinical practice needs to synchronise with modern concepts of chronic pain, including multidisciplinary and multimodal approaches

Key learning points

  • The biopsychosocial model is the preeminent approach to chronic pain management, but it is widely neglected by healthcare providers and patients.
  • In theory, all pain treatments can play a role in individual patients, subject to careful patient selection and multimodal assessment.

Long-term, or chronic, pain is a highly prevalent condition that can have a detrimental effect on an individual’s quality of life as well as great cost to society.1 Over recent decades, we have witnessed an exponential increase in research and publications on the topic.

In particular, the concept of chronic pain itself has undergone a paradigm shift.2 Presently, chronic pain is considered as a biopsychosocial phenomenon, meaning a combination of physical dysfunction, beliefs, coping strategies, distress, illness behaviour and social interactions. This conceptual framework, supported by a wealth of scientific evidence, implies a multimodal and multidisciplinary treatment approach with the aim of maximising pain reduction, quality of life, independence and mobility.2,3

Resistance to applying the biopsychosocial approach

Nevertheless, in many European healthcare systems, knowledge of this phenomenon is ignored and a plethora of treatments, mostly focused on peripheral anatomical targets, are offered at great cost to public healthcare systems.4 At the same time, modern multimodal approaches are offered only sparingly, at great individual cost to the patient. Many patients and healthcare providers opt to stay in their comfort zones. Indeed, it is much easier to stick to the peripheral anatomical pain generator paradigm than to wade into the muddy waters of biopsychosocial concepts.

Many ‘mock-curative’ medical-technical interventions are offered to chronic pain patients with the risk of inducing new iatrogenic problems. In theory, every single approach can play a role in an individual patient, but the indications for medical-technical interventions, including pharmacotherapy, must be scrutinised, well-selected and re-evaluated in a multimodal framework.

In conclusion, medical daily practice often neglects the biopsychosocial model of chronic pain. Let’s get out of our comfort zones and focus more on ‘train the brain’ concepts.3 Hopefully, this will help our chronic pain patients to live a valued life, despite some level of ongoing pain.


  • Professor Bart Morlion is director, Leuvens algologisch centrum, UZ Leuven, Belgium

References

  1. Breivik H, Collett B, et al. European Journal of Pain 2006;10(4):287–333.
  2. Morlion B. Nature Reviews. Neurology 2013;9(8):462–473.
  3. Moseley GL, Butler DS. The Journal of Pain 2015;16(9):807–813.
  4. Kress HG, Aldington D, et al. Current Medical Research and Opinion 2015;31(9):1743–1754.

Date of preparation: January 2015; MINT/PAEU-15034