Page 13 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Musculoskeletal pain
Musculoskeletal pain (MSP) is one of the most important disorders accounting for the global burden of years lived with disabilities (YLDs)37,61 and a significant factor affecting the wellbeing of people. Globally, almost half of the YLDs due to MSP in 2010 was attributable to low back pain (LBP) (49.6%), followed by neck pain (20.1%), other musculoskeletal disorders (17.3%), and osteoarthritis (OA) (10.5%), with relatively small contributions from rheumatoid arthritis (RA) (2.3%) and gout (0.1%). The increasing proportion of elderly people in the global population, with even more rapid growth in less-developed countries, predicts an increasing prevalence of MSP which is therefore expected to become a major global health problem in the coming decades4.
Management of musculoskeletal disorders, with LBP as the most prevalent one in recent decades, is challenging, and action was called for in the Lancet’s Low back pain series (2018)9,10,13,19. The authors came to the conclusion that, while LBP is a complex condition, it is an extremely common one in populations world wide19. It is widely recognized that pain can persist in the absence of visible tissue damage or beyond the normal time of tissue healing15,25,30,41-43,62-64. Persistent pain is defined as pain lasting beyond this normal time, usually taken to be 12 weeks40, and is a condition that needs to be addressed from biomedical, psychological, and social perspectives. Such approaches do not only apply to LBP but are also indicated for persistent musculoskeletal disorders in general5,11,20,30,36.
The challenge: from a biomedical model to a biopsychosocial model
The biomedical model
The biomedical model, focusing on purely biological factors, was the predominant health care model in industrialized countries until the mid-twentieth century. Then a new model was introduced by, notably, Engel: the Biopsychosocial (BPS) model12. Engel’s contribution to the way illness, suffering, and healing should be viewed is that these should not solely be approached from a biomedical point of view but also from their interaction with diverse causal factors, such as psychological and social12. Health care professionals have historically been trained in the biomedical model, the essence of which is that physical complaints can be explained by the biological processes underlying an illness or disease. This model, however, does not explain chronic MSP, as often no obvious biological cause for the disorder can be found. Research has shown that these chronic complaints are, among others, associated with psychological factors3,32,35,46,48. As purely medical approaches have proved unsuccessful, a shift has occurred towards applying the biopsychosocial model in practice. This holds that the
General introduction
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