Page 14 - THE PERCEPT STUDY Illness Perceptions in Physiotherapy Edwin de Raaij

Chapter 1
experience of pain and responses to pain are sculpted by complex and dynamic interactions of biological, psychological, and sociocultural factors38,47,51.
The biopsychosocial model
Ever since the introduction of Engel’s biopsychosocial model (Figure 1)12, health care providers have been encouraged to assess illnesses from a biopsychosocial perspective6.
This was also put forward in the Lancet series
that highlighted contributing factors to LBP and
disability, such as genetics, biophysical factors,
comorbidities, social, and psychological factors,
emphasizing the need for a biopsychosocial
approach10. To reiterate, this approach to the
management of LBP takes into consideration not
only biomedical variables but also psychological
variables (such as behaviour, emotions, and
beliefs) and social variables (such as cultural PS norms and values, social network support,
Figure 1
B
socioeconomic status). For other persistent
musculoskeletal disorders, contributing factors
for pain and disability include widespread nature
(≥ 2 pain sites), high levels of functional disability,
somatization, and high pain intensity1. Additionally, psychological factors such as distress, depressive mood and somatization have been identified as risk factors in general for the transition from acute to chronic pain46.
The World Health Organization recognizes that persistent pain can be seen as a chronic condition in itself, instead of a symptom, and has added ‘chronic pain’ to the International Classification of Diseases, seeing it as a centrally important chronic condition in primary care54. For the management of chronic conditions, such as persistent pain, many theories and biopsychosocial models have been proposed: the onion model by Loeser33, the neuromatrix by Melzack39, the Common-Sense Model (CSM) by Leventhal26, the mature organism model by Gifford15, the fear avoidance model by Vlaeyen60, and, recently, the predictive processing model proposed by Ongaro and Kaptchuk45.
Within the physiotherapy community, the paradigm shift from a biomedical model to a biopsychosocial one has proved challenging. There is a growing body of literature confirming that physiotherapists do not yet (fully) address psychosocial problems or patient beliefs22,50,56,59.
12
B = Biomedical; P = Psycological; S = Social