Criticisms of the biopsychosocial model in spine care: creating and then attacking a straw person

Abstract

Study design: Spine update on some major misconceptions of the biopsychosocial model.

Objective: To refute some of the erroneous beliefs about the weaknesses of the application of the biopsychosocial model to spine care.

Summary and background data: Currently, the biopsychosocial model of illness is the most heuristic perspective in understanding the etiology, assessment, treatment, and prevention of pain-related disorders such as spinal pain and disability. Only the misuse of the biopsychosocial model by inappropriately trained health care specialists decreases its maximum utility and validity.

Methods: This is a point-by-point response to a previous article in Spine, which inaccurately discussed some assumed limitations of the biopsychosocial model as related to spine care. It is also a more comprehensive review of the model and related clinical applications. Articles from the scientific literature are cited in refuting those assumed limitations.

Results: The previous article in Spine provided a superficial, and often erroneous, review of the biopsychosocial model of illness. In providing a point-by-point refutation of that review, a number of important clarifications were delineated. For example, concerns raised about the sole reliance of self-report outcomes are shown to be unfounded. By definition, the "bio" "psycho" "social" underscores the important interactive contribution of factors in each of these defining domains, and requires their individual assessments. It was also erroneously stated that there was an inherent "disconnect" between physical pathology and self-report in this model. However, the richness of the biopsychosocial model is the recognition of the need to continue to understand the pathoanatomic and pathophysiological explanations of spinal disorders (the bio part of the equation), as well as the psychosocial factors that may also be important (the psychosocial part of biopsychosocial). Other questions raised about the scientific status of the model, the effectiveness of treatments based on the model, and so forth, were also addressed.

Conclusion: In agreement with the earlier Spine update, the "...biopsychosocial model has been readily adapted to all aspects of spine care with many positive implications." However, the author then raised some apparently major concerns. These concerns were shown to be unfounded. In point-of-fact, there is an ever-growing scientific literature demonstrating the heuristic value of this model in developing more effective assessment and treatment methods for spinal disorders, as well as guiding greater "cutting-edge" research on their etiologies and potential prevention techniques.