Fernando replies, “My lower back has been hurting for more than a week, and it seems to worse everyday. I take painkillers occasionally during work, but the pain comes back after I close the bar.”
Massage therapist A thought, “Maybe his quadratus lumborum and psosas are tight. Look at his hip. He has an anterior pelvic tilt and is leaning toward his right.”
Massage therapist B, who remembered that Fernando had went through a bad divorce last year, has been working as a bartender at this busy bar for over 12 years, and never complained about back pain in the past six years, thought, “His back may be tight, but after what he has gone through, maybe his back pain all in his head.”
Massage therapist C, however, asked Fernando, “Have you seen a doctor or physiotherapist? How have you been recently? Did you sleep well last night?”
There is a tendency of us to identify the cause of someone's pain with a narrow, biased perspective. While there is no way of knowing exactly what caused the bartender's back pain just by looking at him, considering his lifestyle, or reading his vitals, taking considerations of various factors — hence the accepted term “biopsychosocial” to describe diseases and pain — and how they interact with each other can help us decide the best treatment plan and how we communicate with a particular client or patient.
Physiotherapy professor Dr. Gwendolen Jull from The University of Queensland in Australia wrote in an editorial that the BPS model has its limitations because of its broadness in definition and in nature.
“It does not guide, recommend or restrict which features should be evaluated in any domain. The clinician is free to choose from a variety of potential tests, so approaches to patient evaluation risk reflecting the professional or attitudinal bias of the clinician. Neither does the model nform on how one domain may or may not influence or interact with another domain.” (2)
Thus, each domain of the BPS model “will most likely change as the patient progresses through the course of the disorder.” And so, one or two domains would have a higher priority or influence than the others. A more accurate visual of the BPS model would be something like this below.
In the middle model, social context may affect how much pain a patient, even after the tissues have healed. This patient may experience the same injury as the one in the first model, but she might worry that her injury might prevent her from competing a track and field event, limit her ability to care for her kids, or affect her income in which her job requires her to stand for a long time. This model may interchange with the third model since the social context of the injury affects her thoughts and emotions.