The biopsychosocial model of lower back pain

How psychosocial stressors change your experience of pain

The biopsychosocial model basically means addressing the problem of chronic pain in three ways:

  1. bio=any biological considerations ie injury or illness
  2. psycho=how you think and feel about the problem
  3. social=how family, work and social pressures contribute to the problem.

I meet people on a daily basis who are deeply distressed and disabled by their back pain. It is (fairly) unusual to see such a high level of distress and interference with normal life with other bone, joint and muscle conditions. With a few exceptions it is mainly lower back pain that causes us such particular problems.


Gordon Waddell MD in his excellent book ‘The Back Pain Revolution’(1) describes Back pain as ‘a 20th Century medical disaster’. He points out that despite medical knowledge growing and becoming more and more sophisticated we are no nearer to solving the problem of simple backache.

Why is it that despite medical advances we still have a huge problem with lower back pain?

One of the things that is so striking about lower back pain is the lack of any relationship between the tissue damage, pain and disability.

 It would be natural to assume the following happens:

Increased tissue damage = increased pain = increased disability = increased distress.

Unfortunately in real life it is not so clear.

biopsychosocail stressors acan lead to isolation and depression in chronic lower back painMany people with low back pain report high levels of pain, distress and disability independently of tissue changes. I have met plenty of people with very serious spinal problems who get on well in their lives and others who are totally incapacitated by simple back pain. Read this section on redefining pain to understand how pain is experienced.

The relationship between having lower back pain and the effect it has on your life is very complex. This is often confusing for both back pain sufferers and those of us trying to treat it.

Waddell (1) points out that the incidence of back pain has remained relatively unchanged but that we are taking more time away from work and leisure activities  because of back pain. The numbers of people with back pain are much the same but the amount of disability associated with back pain has increased dramatically.

Why is it that lower back pain causes such distress?

This phenomenon has led in recent years to a new, fresh approach to helping people understand and manage their back pain. This new approach acknowledges that lower back pain has many facets, that it is not simply a physical or biological event but that it is closely tied in with the social circumstances and psychology of the individuals experiencing it.  This more modern approach to back pain is described as the biopsychosocial model.

An outline of the biopsychosocial model

biopsychosocail model of lower back pain

If you are to overcome your back pain and learn how to manage it you have to think about some of these other factors. If you haven't read it yet I suggest you look at this section which explains up to date thinking about pain .

Yellow Flags and Psychosocial Stressors

Recently more researchers have started to look at how we think and feel affects lower back pain. A number of thoughts, beliefs and behaviours have been identified that are psychosocial stressors and that increase your chances of becoming distressed and disabled by chronic lower back pain. These are related to the biopsychosocial model and are called yellow flags. Managing these is the key to biopsychosocial rehabilitation.

This is NOT the same as saying pain is imagined and psychological in origin i.e. made up or imagined. Back pain is absolutely real, real and disabling and distressing for many. Do not think the biopsychosocial model dismisses your pain as ‘all in the mind’.

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(1) Gordon Waddell. The Back Pain Revolution. Churchill Livingstone; 1998.

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