What Is the Biopsychosocial Model?
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When you are in a position to treat or assist people with chronic pain conditions, you have probably noticed the inadequacy of the biomedical training you have received.
The traditional biomedical model taught in medical schools, and many schools of allied health, considers pain to be caused by a structural or muscular problem of the body. However, decades of medical research have shown unequivocally that chronic pain is not associated with structural findings on imaging studies, like X-rays and MRIs (Kasch et al., 2022). Because the assumptions of the biomedical model have not been borne out by research or treatment evidence, the biopsychosocial model has emerged as an alternative explanation for persisting pain. |
Symptoms are affected by all three aspects of a person's life.
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The biopsychosocial model was initially developed by Engel (1980) and has been a useful model for describing health issues that are impacted by biological, psychological, and social factors. In contrast to the biomedical model of chronic pain, the biopsychosocial model takes a much broader, whole-person view of chronic pain production.
The biopsychosocial model cannot and does not provide a clear, descriptive pathway showing how psychological and social factors “cause” pain to persist. However, it does help people make sense of pain that may persist even after treatments based on the biomedical model have failed to reduce the pain.
Recently, particularly in mental health treatment settings, the name of the model is being intentionally expanded to emphasise the importance of both cultural and environmental factors in health and illness (Collins & Jay, 2025). These factors are included in Engel’s (1980) original biopsychosocial model under the term ‘social’ (as macro-social factors called ‘Community’, ‘Culture-Subculture’, and ‘Society-Nation’, as opposed to micro-social factors like family relationships). However, these important social factors unfortunately receive little attention in interventional studies for chronic pain.
Obstacles exist to the adoption of the biopsychosocial model in clinical practice. Many of those obstacles are built into the systems in which healthcare professionals work. Insurance may only cover physiotherapy or spinal fusion for persisting back pain, for example, rather than psychotherapy or other emotion-focused therapies (Abbass et al., 2021), even when physiotherapy and spinal fusion are not shown to be effective long-term without additional psychotherapeutic support.
Thus, clinicians need further education on how to work within the biopsychosocial framework (Miró et al., 2023). Leysen et al. (2021) showed that as physiotherapy students progress from 2nd to 4th year of education, their adherence to current biopsychosocial guidelines increases. However, physiotherapists report difficulties exploring and explaining psychosocial aspects of pain to patients with chronic back pain (Wellman et al., 2020; Zangoni & Thomson, 2017) despite themselves understanding the concepts.
Jordan et al. (2023) showed that pediatricians must tread carefully when explaining nonspecific chronic pain to children and their caregivers, and that the timing and wording of the explanation are important. Adults have expressed feeling invalidated if psychosocial factors are indicated for the presence of their chronic pain (Nicola et al., 2021), therefore methods of communicating that are absent of judgment or stigma are important for maintaining a positive clinical relationship.
Simply providing clinician training on biopsychosocial concepts is clearly not adequate for inspiring a change in practice from the biomedical to the biopsychosocial model. Extensive training in the relationship-building skills featured in person-centered communication is required.
The majority of this text was adapted from Sara D. Hauber's original PhD thesis, Chapters 1 and 6. All referenced articles appear at the bottom of this page.
The biopsychosocial model cannot and does not provide a clear, descriptive pathway showing how psychological and social factors “cause” pain to persist. However, it does help people make sense of pain that may persist even after treatments based on the biomedical model have failed to reduce the pain.
Recently, particularly in mental health treatment settings, the name of the model is being intentionally expanded to emphasise the importance of both cultural and environmental factors in health and illness (Collins & Jay, 2025). These factors are included in Engel’s (1980) original biopsychosocial model under the term ‘social’ (as macro-social factors called ‘Community’, ‘Culture-Subculture’, and ‘Society-Nation’, as opposed to micro-social factors like family relationships). However, these important social factors unfortunately receive little attention in interventional studies for chronic pain.
Obstacles exist to the adoption of the biopsychosocial model in clinical practice. Many of those obstacles are built into the systems in which healthcare professionals work. Insurance may only cover physiotherapy or spinal fusion for persisting back pain, for example, rather than psychotherapy or other emotion-focused therapies (Abbass et al., 2021), even when physiotherapy and spinal fusion are not shown to be effective long-term without additional psychotherapeutic support.
Thus, clinicians need further education on how to work within the biopsychosocial framework (Miró et al., 2023). Leysen et al. (2021) showed that as physiotherapy students progress from 2nd to 4th year of education, their adherence to current biopsychosocial guidelines increases. However, physiotherapists report difficulties exploring and explaining psychosocial aspects of pain to patients with chronic back pain (Wellman et al., 2020; Zangoni & Thomson, 2017) despite themselves understanding the concepts.
Jordan et al. (2023) showed that pediatricians must tread carefully when explaining nonspecific chronic pain to children and their caregivers, and that the timing and wording of the explanation are important. Adults have expressed feeling invalidated if psychosocial factors are indicated for the presence of their chronic pain (Nicola et al., 2021), therefore methods of communicating that are absent of judgment or stigma are important for maintaining a positive clinical relationship.
Simply providing clinician training on biopsychosocial concepts is clearly not adequate for inspiring a change in practice from the biomedical to the biopsychosocial model. Extensive training in the relationship-building skills featured in person-centered communication is required.
The majority of this text was adapted from Sara D. Hauber's original PhD thesis, Chapters 1 and 6. All referenced articles appear at the bottom of this page.
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