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How To Effectively Treat Chronic Low Back Pain Using The Biopsychosocial Model

Do you suffer from recurring or chronic low back pain?

Many clinicians, including doctors, physical therapists, and chiropractors, are treating chronic low back pain (CLBP) incorrectly.

The latest research and evidence-based information now regard the biopsychosocial treatment model as the most effective treatment model for chronic low back pain.

I have to make an early disclaimer though:

The biopsychosocial model of treatment is not ideal for all people. If you are looking for a quick fix to treat your chronic low back pain, the biopsychosocial treatment model will not work for you.

On the other hand, if you are willing to invest some time and effort, and you’re looking for an effective, long-term solution for your chronic low back pain, read on…

In fact, this is the treatment model I’ve used to help my patients achieve freedom from the grip of chronic pain and dysfunction.

The best part is many of my patients did it themselves from the comfort of their own homes!

In this article, we will explore how you can use the biopsychosocial model to find relief from your pain and symptoms without relying on pain medications, steroid injections, and even surgery.

What is chronic low back pain (CLBP)?

low back pain infographic

CLBP is defined as continuous or recurring pain that lasts for 12 weeks or more after an initial injury or underlying cause of acute low back pain has been addressed.

Over 70 percent of people in developed nations will experience low back discomfort at least once, which typically resolves within two weeks. However, at one year, around 10% are still unable to work and 20% have persistent symptoms.

Prior to using the biopsychosocial model to treat their CLBP, many patients report their symptoms would range from feeling like a dull muscle ache to a shooting, burning, or even a stabbing sensation. In addition, the pain may radiate down to their buttocks or leg or get worse with bending, twisting, lifting, standing, or walking.

Even if pain persists, it does not always indicate that there is a medically significant underlying cause for CLBP or that the acute pain and symptom from the original injury have not healed.

What is the biopsychosocial model of treatment?

Biopsychosocial Model

The biopsychosocial model has been defined as a way of thinking and conducting clinical care, as well as a framework for clinical practice.

It proposes that pain, disease, or illness are caused by a variety of things ranging from physical (tissues, structures, molecules) to cognitive (thoughts, belief, attitude) and social (social influences, environment) causes.

Each of these elements affects your experience with pain, your response to treatment and therapy, and your clinical outcome.

The biopsychosocial method of delivering care incorporates the physical, psychological, and social aspects of your illness or injury and seeks to combine treatment techniques in order to promote a more comprehensive approach.

With the biopsychosocial model of treatment, you are not just a body part; you are a whole body.

Why is the biopsychosocial model the most effective way to treat chronic low back pain?

The biopsychosocial treatment model is an effective way to treat CLBP because it takes into account not just your physical discomfort but also the mental and emotional factors that contribute to prolonging your pain and dysfunction.

For a long time, healthcare providers, including doctors, physical therapists, and chiropractors, have always believed that pain management should be focused on the sensory modalities and problems identified solely on a biological or physical level.

This could explain why some of the pain management treatments you have tried in the past have not worked. It’s possible the pain interventions you’ve had were based on old and outdated information.

Today, pain researchers and scientists view pain not as a purely physical experience. Pain is not just a product of an injury in your body; rather, pain is a multidimensional experience that is informed by what you think, believe, or feel and even influenced by your environment and social interactions.

Even when pain is triggered by tissue damage, the actual sensation of pain doesn’t emanate from the tissues themselves but rather is amplified and felt in your brain through your nervous system.

That is why using the biopsychosocial model for treating your chronic low back pain is so effective – it is a comprehensive treatment model that results in long-term relief!

Applying the biopsychosocial model to the treatment of your chronic low back pain:

So now that you’ve seen why the biopsychosocial model is the most effective treatment framework for your chronic low back pain, how do you apply the framework?

Let me show you how I apply the framework while using the 7 Essential Movements Against Back Pain, a FREE guide I included in this article…

STEP #1 The Cognitive (Psych) Component

Long before you break out into those different stretching and core strengthening exercises your physical therapist has taught you…

pause for a few minutes…

sit down…

close your eyes…

breathe…

Our brains are neuroplastic, which means that they constantly change and adapt from the inputs and experiences in our lives.

When pain becomes chronic, it changes the way your brain and nervous system work.

Your brain and nervous system become hypersensitive to pain signals – the more you experience pain, the greater the chance of pain reoccurring as your body’s living alarm system (your brain and nervous system) is stuck in a state of high alert!

Follow this Graded Motor Imagery Technique I outline below to help your brain lower down its hypersensitivity to pain…

Part 1

  1. Set aside 10-15 minutes in a quiet place where you can focus on yourself, away from distractions.
  2. Download the FREE guide, 7 Essential Movements Against Back Pain.
  3. Look at the unique positions and movement patterns in the guide.
  4. Observe your body’s physical and emotional reaction to the images.
  5. Try to notice any feelings of unease, discomfort, tension, dread, or even fear.
  6. If you experience physical sensations (i.e. aching, burning, shooting, radiating, etc.), note where they are happening and how intense the sensations are.
  7. Ask yourself, “Can looking at the images of the unique positions and movement patterns in the guide harm my back?” or “Why am I feeling these physical sensations by just looking at the images?”
  8. Spend 5 minutes writing what you noticed in your body during this experience. What sensations did you feel? What emotions came up? Were you surprised by how comfortable or uncomfortable you felt by just looking at the images?
  9. If you felt too overwhelmed by simply looking at the images in the guide, consider completing Part 2 at a later time. If you feel safe after looking at the images, continue to Part 2.

Part 2

  1. Close your eyes and imagine that YOU are the person performing the unique positions and movement patterns in the guide.
  2. Imagine that you are the one performing the movement patterns without the feelings of unease, discomfort, tension, dread, or fear.
  3. Breathe.
  4. Imagine how relaxed and at ease you are in performing the movements.
  5. Spend 5 minutes writing what you noticed in your body this time. What sensations and emotions did you feel? Were you surprised by how comfortable or uncomfortable you felt?
  6. How did it feel to complete all the movements freely in your imagination?
  7. If doing Part 2 felt safe for you, then you are ready for Step #2.

 

STEP #2 The Physical (Bio) Component

  1. Remind yourself of how safe you felt in Part 2 while imagining the different positions and movement patterns.
  2. Remember how you felt when you freely and with ease completed all the movements in the guide?
  3. Now, physically perform the 7 Essential Movements Against Back Pain, reminding yourself that you are safe… and comfortable… and at ease while performing the movements.

If you successfully completed Step 2 without any feelings of unease, discomfort, tension, dread, or even fear, CONGRATULATIONS!

You just had what is called a “corrective experience”.

You were able to unlearn your fear of movement and replaced it with a new association: Different Positions and Movement Patterns = SAFE!

If you feel safe during exposure to movement and activity (the source of your fear), you underwent a corrective experience. Keep repeating Steps 1 and 2 and your brain will learn that the signals coming from your body (the feelings of unease, discomfort, tension, dread, or fear) are, in fact, safe.

STEP #3 The Social Component

So how do you ensure that you’re able to perform Steps 1 and 2 consistently; enough to create a string of corrective experiences?

That is where the value of the social component of the biopsychosocial model comes in. Identify a person/s in your social circle that will hold you accountable to the schedule and goal you have expressed.

These are your accountability partner/s who will remind you and cheer you on when the going gets tough. Chronic low back pain can be an isolating experience. Surround yourself with people who will root for your success.

If you followed the framework I outlined for you, you have just learned how to implement a comprehensive back pain relief program! Use this technique repeatedly and see the amazing results for yourself.

I gave some more examples and explained how to use the biopsychosocial model in treating chronic low back pain in my book Back Pain Unlocked.

Frequently Asked Questions

Can chronic lower back pain be cured?

YES. The latest research and study of pain neuroscience has provided us evidence that our brain undergoes changes (aka neuroplasticity) in response to chronic low back pain.

Often, the acute or initial injury that resulted in your back pain has already healed, but your brain, in its role of protecting you, has remained hyper-alert to your physical sensations.

Using the biopsychosocial model of treatment, you can address the different components that contribute to and prolong your pain experience.

Why is my back pain not going away?

Pain is a message.

It is our brain and body’s way of communicating with each other, telling each other, “Hey, there’s an actual or perceived threat to the body!”

When your brain receives pain signals over and over, it changes in such a way that reinforces chronic pain. The brain’s adaptation and hypersensitivity to pain are called neuroplastic pain (also called central sensitization).

In most cases, pain caused by a physical condition or injury will not become chronic or persistent. It will heal or respond to medical treatment or physical therapy or recover on its own.

Acute pain can result from a physical or structural diagnosis and is expected to resolve or heal in 12 weeks or less.

Meanwhile, chronic pain is mostly caused by neuroplastic pain, thus are more likely to last for several months or even years.

Which position puts the least pressure on the back?

Depends.

I know that is not a very helpful answer, but that is the right answer. In my article, “To Bend or Not To Bend”, I explain the back’s direction preference and why it is important to be aware of it and to use it in your own back exercise program.

Is it best to rest a bad back?

No. Not moving in order for your back pain to get better is a myth.

Multiple research studies have shown that not moving enough can actually worsen your back pain, not resolve the problem.

A systematic review of studies for the management of back pain has recommendations for more, rather than less, activity in recovery.

Conclusion

For a long time, we have treated chronic low back pain using the old and outdated biomedical model.

By using the biomedical model, we treat back pain as a problem with a body part, not as a multidimensional pain experience.

Clinicians, including doctors, therapists, and chiropractors focus on the back alone and forget the role of the brain and the different influences of our beliefs, emotions, stress, and environment.

That is how many chronic low back pain sufferers end up with pain medications, steroid injections, invasive spinal surgeries, electrical stimulation, ultrasound treatment, spinal manipulation, or spinal “adjustment”.

They treat the back. Not the whole body.

It is time to look at your chronic low back pain from a global perspective and use all the tools in the arsenal available to you by using the biopsychosocial model of treatment.

Dr. Lex Gonzales
Dr. Lex Gonzales, PT, DPT is an author and speaker who has been working as a licensed healthcare professional for over 24 years. On drlexgonzales.com he provides quality information and practical solutions you can use to achieve the best version of your healthy self.

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