Biopsychosocial Model

Biopsychosocial History

For a long time, people treated pain only as an indication that the body was hurt in some way. If something hurt, physicians assumed something was injured, inflamed, or broken. If a scan or test looked normal, or the healing process was complete, people in pain would often be dismissed, ignored, or told their pain was all in their head.

In 1977, a physician named George Engel offered a different framework. He suggested that pain was more than a biological response; it was also shaped by how you think, feel, and live your life. Engel referred to this pain experience as the biopsychosocial model.

At the time, with the biomedical model, if a physical abnormality or pathology could not be identified, the patient’s pain was often dismissed as it was often a secondary, subjective psychological response. This is why some physicians are known for telling their patients, “This is just in your head.”

Engel argued that this approach was incomplete; pain can exist without injury, but he was in an uphill battle for four primary reasons.

1. The biomedical model had and still has real power. It has produced major advances in treating infection, life-saving surgery, and managing acute disease. Many physicians believed expanding the biomedical model could dilute scientific rigor and reduce care effectiveness. They argued that integrating a patient’s thoughts, emotions, and social welfare would be a step back in clinical care. Others criticized it as more of a human orientation than a true scientific model.
2. Western medicine was not concerned with the mind-body connection because the body belonged to medicine. Engel believed this split was artificial and harmful to clinical care. 
3. The biopsychosocial model was easy to criticize as imprecise; many thought it was too broad and challenging to use because it lacked practical treatment paths for their patients.
4. Medicine was becoming more specialized, molecular, and procedure-driven, which moved the focus from the individual’s personal experience toward a narrow biological explanation. 

BPS Model Today

The biopsychosocial model of pain is more widely accepted today than it was in the past. Many pain clinics, rehab programs, and educational materials now say they use the BPS model. While the model is more present today, it has its own complications.

• The BPS model is watered down: Clinics may say they use the biopsychosocial model, but still default into body-first thinking.  The psychological and social parts become add-ons rather than true parts of care. This often shows up in men’s and women’s specialized clinics that claim a holistic approach while primarily pushing pharmaceutical interventions.
• It can be used as a weapon against patients: This is when the physician believes you are overstating your symptoms and they cannot find enough observable evidence. This may result in “We didn’t find anything in the scan; this is a psychological issue,” or advising you to push through a painful activity even when your body is warning you to stop.
• The physician’s understanding of the BPS model is incomplete:  While the provider may know about and have a vague understanding of the model, they reduce every painful sensation into an oversimplified explanation to the person living with pain, often as “it’s in your head, you just need to change how you think,” without care and guidance on how to do it.
• Critics say it is too vague: Scholars still argue that the model is too broad, difficult to use, and lacks clinical procedures to apply effectively. The vague component is often tied to the model’s ambiguous social component. Biology and psychology are far easier to address than housing, work strain, poverty, isolation, or the experience of not being believed.

In the past, this model faced adversity primarily because of rejection; today, it is about whether the model is being used appropriately and accurately.