Arguments Against Biopsychosocial Model of Spine Care

Recently, a researcher, B.K. Weiner, published an article that focused on back pain being deemed biopsychosocial, related to biology, psychology, and social aspects of life. He combined this with the heuristic approach, which means problem solving for the most appropriate solution one step at a time, not necessarily the best solution. In his article, he also wrote about the strengths and weaknesses of this approach, as he saw them, but he focused on the strengths and why this model should be discouraged. The authors of this article disagreed with Weiner's discussion, particularly the weaknesses, and wrote to present why they disagreed.

Weiner had suggested that there is a weakness in relying on patients to self-report problems, which is when they keep track or answer questions about how they felt or what they did. This article's authors suggest that self-reporting is necessary using the biopsychosocial model because of the very issues that are covered: the patients' behavior, how they felt, how they coped, how they worked, and so on). The authors do point out that researchers can't rely on self-reporting alone, but it does have its place in an overall study and that self-reporting can't be considered as more important or less important than any other type of study measurement.

The next point that Weiner makes is that historically, as medicine progressed, has made several errors in connecting certain illnesses and diseases to some aspects of psychology. By doing this, doctors and researchers lost valuable research time by believing the wrong things. He then says that using the biopsychosocial model will also fall into this trap. The authors of this article point out that Weiner incorrectly uses the Type A personality and blood pressure connection. Weiner says that believing that Type A personalities had higher risk of high blood pressure slowed down research. The authors here argue that knowing that Type A personalities have a higher risk of high blood pressure has actually spurred on research, particularly in the realm of stress.

The authors continue by pointing out that using this model, researchers were able to connect the dots when it came to learning about type 2 diabetes and lifestyle, asthma, and some other disorders. By using the biopsychosocial model, researchers were able to look beyond the physical issues and see what else could be contributing to various problems.

Another point made by the authors is that the chronic diseases don't have cures but are merely managed. In respect to spinal problems, there too are no cures in the offing. But, by knowing that some lifestyle changes can affect the progress of spinal injuries, they can make life easier for the patients, if not cure the problem. But, to make those changes, researchers need to know what causes the problems in the first place.

Weiner points out that in science, the answers need to be proven or disproven; there has to be a yes or no, and if you take into account the biopsychosocial model, researchers don't have the clarity of a testable or falsifiable aspect to fall back on. The authors disagree with this argument, saying that it is possible to test for variable issues, although researchers do have to take into account that the are, in fact, variable.

One very helpful outcome of the biopsychosocial model is the newer team, all-inclusive, method of treating patients. When at one time only one specialty or specialist would manage a patient, now a multidisciplinary team is common.

As many treatment options are tried, doctors are learning by trial and error which are most effective. While Weiner suggests that this is only for the biopsychosocial model, the authors of this article point out that this is so for most treatments for back pain. They also point out that there can be great differences between different clinical treatment teams running the studies in different countries or environments. The actual studies remain identical, the medications or procedures, but the social and psychological issues can differ from place to place, as can the biology of the patients. Therefore, this teaches researchers a lot when findings come in differently from different areas.

The last concern that the authors take issue with is the complaint that by using the biopsychosocial model, the medical community is "medicalizing" patients with spinal problems. The authors argue that doctors can't isolate the back pain and to do so would make it much more difficult to provide adequate treatment. To treat back pain, it's essential to treat the whole person, including the social and psychosocial issues that could be contributing to back pain.

Robert J. Gatchel, PdD, ABPP and Dennis C. Turk, PhD. Criticisms of the Biopsychological Model in Spine Care. In Spine. December 1, 2008. Volume 33. No. 25. Pp. 2831-2836.



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