Introduction
Pain is more than just a physical sensation and is influenced by multiple factors. These including emotions, beliefs, and one’s social environment. For years, physiotherapy primarily focused on treating pain through a biomedical lens—targeting muscles, joints, and tissues, trying to fix them. However, over time and with research, modern pain science has actually shifted towards a more holistic model known as the biopsychosocial (BPS) approach.
This model was introduced by Dr. George Engel in 1977, which challenges the traditional biomedical perspective and emphasizes the complex interactions between biological, psychological, and
social factors in pain and rehabilitation.
So, why should physiotherapists and patients embrace this paradigm shift? Let’s explore how research shows this approach leads to faster recovery, improved pain management, and long-term well-being.
The Biopsychosocial Model: A New Way of Understanding Pain
What is the BPS Model?
Instead of viewing pain as purely a result of structural damage, the BPS model recognizes three key influences:
- Biological – Muscle imbalances, nerve function, joint restrictions, inflammation, and tissue sensitivity.
- Psychological – Beliefs about pain, emotional regulation, stress, and fear of movement.
- Social – Work environment, relationships, financial stress, and cultural influences. Pain is not just a mechanical issue—it’s an experience shaped by our beliefs and environment.
For Example: Two people with the same MRI findings for a herniated disc may have completely different pain experiences. One might be in constant agony, while the other feels no symptoms at all. Why?
- The first patient may have high stress levels, poor sleep, and have developed a fear of movement, amplifying their pain.
- The other, may have strong coping strategies, a supportive social environment, and positive beliefs about recovery, reducing their pain response. This highlights why treating the whole person—not just the injury—leads to better results.
The Biological Component: More Than Just “Tight Muscles”
Did you know, many patients believe pain is solely due to tissue damage. And while these structural issues play a role, pain is also influenced by one’s nervous system, inflammation, and movement patterns.
The Key Biological Factors in Pain:
- Muscle Dysfunction: Weakness, hypertonicity (tight muscles), poor motor control.
- Central Sensitization: The nervous system becomes overly sensitive, making normal sensations feel painful.
- Inflammation: Chronic inflammation increases pain perception.
- Sleep & Recovery: Poor sleep heightens pain sensitivity and delays healing.
Clinical Example: Research done by Moseley & Butler (2015), shows that gradual exposure to movement, combined with pain education, will help retrain the patient’s nervous system, allowing patients with chronic pain to move with less fear and more confidence.
How Physiotherapists Can Help:
- Use pain neuroscience education to reframe a person’s negative beliefs about pain.
- Implement graded exposure therapy to reduce movement-related fear.
- Teach breathing and relaxation techniques to regulate the nervous system.
The Psychological Component: How Thoughts and Emotions Shape Pain
The brain plays a crucial role in pain perception. Did you know, if someone believes their pain is dangerous, it actually makes it feels worse? And if they feel helpless, recovery actually slows down. Addressing these kind of negative thoughts and emotions, and implementing healthy coping strategies is crucial and just as important as physical rehabilitation. Common Psychological Barriers to Recovery:
- Pain Catastrophization – Thinking “This pain will never go away” leads to increased distress and disability.
- Fear-Avoidance Behaviours – Avoiding movement due to fear of pain, causing muscle weakness and stiffness.
- Stress & Anxiety – Chronic stress amplifies pain perception through the nervous system.
Key Research Insight:
A study by Quartana et al. (2016) found that high levels of pain catastrophization correlate with increased disability and prolonged recovery. Put simply, what you think about pain
affects how much pain you feel.
Management for Pain Catastrophization:
- Use CBT-based strategies to reduce fear of movement.
- Teach guided relaxation and mindfulness techniques to regulate pain perception.
- Encourage journaling or expressive writing to process emotions linked to pain.
The Social Component: The Role of Environment and Support
Pain is not experienced in isolation. Work stress, family dynamics, financial struggles, and cultural beliefs all influence how we perceive and respond to pain.
Key Social Factors Affecting Pain & Recovery:
- Support Systems: Patients with strong family and social support have shown to recover faster.
- Work & Postural Stress: Sedentary jobs and poor ergonomics contribute to musculoskeletal issues.
- Cultural Beliefs: Some cultures view pain as a normal part of aging, leading to delayed Treatment.
- Healthcare Access: Socioeconomic factors determine whether patients can afford therapy and implement treatment.
Key Research Insight:
A 2019 systematic review (Osborne et al.), found that social determinants of health significantly impact pain recovery timelines.
How Physiotherapists Can Help:
- Address psychosocial barriers to treatment adherence.
- Provide accessible home exercise programs for patients with limited mobility or resources.
- Educate patients on ergonomics, posture, and lifestyle changes for long-term pain prevention.
Lifestyle Medicine: Sleep, Diet, and Exercise in Pain Recovery
- Sleep & Pain Sensitivity – Poor sleep increases inflammation and reduces pain tolerance.
- Diet & Inflammation – Anti-inflammatory foods (omega-3s, antioxidants) reduce pain and promote healing.
- Exercise & Nervous System Function – Movement helps “retrain” the nervous system, making pain less threatening.
Key Research Insight:
Dr. David Nieman’s research shows that moderate exercise enhances immune function and reduces chronic inflammation, while overtraining increases pain sensitivity.
How Physiotherapists Can Help:
- Track sleep habits and provide strategies for better rest.
- Encourage anti-inflammatory diets rich in whole foods.
- Use graded activity programs to prevent overuse injuries.
Bridging the Gap: Helping Patients Understand the BPS Model
Many patients expect only hands-on therapy or exercises. When we ask about sleep, stress, or emotions, they may wonder:
Why are you asking about my sleep when I came in for back pain?
What does stress have to do with my shoulder pain?
The Biopsychosocial Model explained:
- “Your body works as a team.” If one part is weak, other parts compensate—sometimes causing pain elsewhere.
- “Pain isn’t just about damage.” Your brain processes pain like an alarm system—sometimes the alarm is too sensitive, making normal sensations feel painful.
- “We treat the whole person, not just the symptoms.” – Addressing stress, sleep, and movement patterns leads to faster recovery.
The Puzzle Piece Analogy “Think of pain like a puzzle. If we only focus on one piece (muscle tightness), the picture is incomplete. But when we put all the pieces together (sleep, stress, movement, mindset), we can see the full picture—and help you recover more effectively.”
Conclusion: A Smarter Approach to Pain Management
The biopsychosocial model is no longer optional—it’s essential for effective physiotherapy. Treating pain holistically leads to faster recovery, better function, and long-term resilience.
Key Takeaways:
- Pain is influenced by biological, psychological, and social factors.
- Addressing beliefs, emotions, and lifestyle improves treatment success.
- Educating patients on pain science helps them take control of their recovery.
Would you like to implement a BPS-based treatment plan for your pain? A pelvic and orthopaedic physiotherapist can help you get started and maintain a resilient recovery!
