When I work, I do my best to use a bio-psycho-social perspective.
That is to tend to the entire individual. I think everyone doing this kind of thing should!
It might sound academically fancy or pretentious, but it mostly means humans are more complex than meat alone. If you’re bothered by pain, you’re quite likely thinking of the first part, the biological one. But we might have to tend to other parts to ease as much suffering as possible. With purely physical problems, it’s easy to tend to nothing but the physical aspects, as with typical physical rehab. The BPS approach seems to do the trick a lot better than if you were to look at the physical part alone – particularly when we try to do something about more complex problems. For example, if the pain at hand originates in something but the physical, if we’re looking at more prolonged pain over months and years with or without pathology or when managing what might not heal. In that case, disability level can increase incredible amounts if you don’t tend to all aspects.
Biological – your physical being.
This is where the poking, prodding, and mechanical stuff happens, and we think about the pain itself; where, when, how, for how long, how did you get it, what if…, can you relieve or make it worse, does any meds help and so on to boil it down best we can. Orthopedic tests could be used to make the pain more or less or look at some other structures’ quality. From this, it’s possible to deduce what seems to be the problem, and hence there’s a diagnosis (Which in this field is more of a good enough guess, however silly that might sound. In other fields, blood samples or x-rays show very objective things that, without hesitation, equal a diagnosis. The x-rays tell us less in this area unless it’s undeniable (fracture or ruptured something, etc.). Arthritis, degenerative things, partial or even complete tears might be utterly irrelevant to the pain bothering the patient.). The correct diagnosis is crucial to good treatment. You’ll need to know why you’re in pain to be able to give it what it needs. How people usually refer to pain is a bit too diffuse; we need to know what structure signals for the pain and, ideally, why it signals as it does. Perhaps we’d like to know why it’s interpreted as it is by the brain because there’s a difference between pain and pain.
The hard part, why people generally have to study this, is because “knee” isn’t one structure. It’s a bunch of small ones. There are many reasons why a knee could hurt since it consists of a bunch of stuff, and there’s plenty more acting on the area.
Then there’s the solution. Most things benefit from some sort of “physical therapy”, which is a broad term, but the biological part can be condensed to something quite simple when we’re treating it conservatively – start where you are and progress to where you want to be. Do that at a speed where your body can adapt to the increasing demand.
Unload initially if something needs that – and then load the tissue in as full of a range of motion as you can. Bonus points for actively using that range of motion in daily life. A change of biomechanics by learning motor control and how something should be used might be helpful unless it’s enough to give it a higher tolerance to stress, so it’ll be fine with what you put it through in daily life anyway.
I quite often treat issues with manual therapy – or teach people to treat themselves – in addition to physiotherapy. That usually includes muscle and joint mobilization to relieve pain and/or increase function. That is, obviously, just useful if it’s relevant to the case at hand, which is why we need the right diagnosis. If a therapist does it or if that’s substituted by self-massage, self-mobilizations and stretching rarely seem to matter.
Medications fit perfectly fine under this category, as well as food-related ones. Trying to cut weight or malnutrition can bother both pain and healing.
Psychological – your psychological aspects.
Today, a lot points to the fact that stress can cause or amplify existing pain. Psychological distress can manifest as physical pain when it gets bad enough. Less than that amount could amplify already existing pain. Unfortunately, stress is A LOT of different stuff, which we, on the one hand, are made to handle – it’s a naturally occurring thing – but on the other hand, we’d preferably be stressed for a while and then get to rest, unlike today.
If you can sort up your life in other “unrelated” ways, taking stuff off your mind and/or physiology that could stress you, that might definitely help. Just something as fundamental as fixing your sleep could be an extraordinary example.
Pain is a stressor itself, so if you’re trying to solve PAIN, you could see that as a catch-22. Relieve pain – get less stressed, and you’ve got something affecting pain positively by breaking a negative spiral. Could there be something that decreases pain, at least in the short term?
In my opinion, fear and uncertainty about your pain are other, usually less thought of stressors. This is why knowledge could be a valuable part of the cure. A diagnosis and what to expect from it could be beneficial because it gives perspective – to some more than others, of course. Learning about your limits makes sure you don’t overextend, or perhaps the opposite, might extend your options beyond what you previously thought possible. Both might instill confidence and certainty, and with those comes a calm.
Social – your surroundings.
The social connects a lot to the psychological aspects in the form of relationships or lack thereof. Social stress from family, friends, colleagues, kids to worry about and take care of, thoughts and worry of love and loved ones passing. The issue could be less dramatic or life-changing than death itself; maybe you miss the social aspect and your place in the team since you got hurt, and now you’re depressed because it’s such a big part of your identity…?
But the biological parts can, without a doubt, be a part here. Living in isolation puts a greater demand on you to do everything. Doing the dishes with horrible back pain or grocery shopping with a newly dislocated shoulder could ruin days ahead.
What did I just read?
This is how we’ll look at things, regardless of if you’re suffering mainly from stress-related things, depression, or pain. It’s all connected, and so are the bio-psycho-social aspects.
It’s not the solution – but the point of view – and it seems to work quite well when the compliance is high enough for people to do their homework. That’s why we can assume that it’ll work just fine when you do the same. I wouldn’t bother with all the text if it didn’t work. Promise. You’re a quite complex biological being. So we’ve got to consider a few more things than you might have thought.
It’s a complex matter.
All of the three big troubles that are the main focus here feed on each other, so it’s often necessary to tend to it in a wide way, rather than just throwing pills at it. Stress and exhaustion increase pain sensitivity and might cause depression. Depression increases pain sensitivity and is a significant stressor. Pain is a major stressor and might lead to burnout and depression.
The symptoms and what turns into the most prominent problem vary from person to person and how bad the case is, but generally makes people quite helpless when they try to get help. A bit of pain, a morning of hopelessness, or a stressful afternoon won’t bother you enough to get help.
When exhaustion is the major problem, feeling useless and performing worse might turn into huge issues because a large part of those who suffer from it are often completely performance-based when valuing themselves. Being worse and performing worse motivates to work harder. All their lives, they’ve solved their problems through sheer hard work, and that’s what they’ll keep trying. Never making progress but struggling on. Fighting harder and suffering more. However, it’s solved with just the opposite; but as long as no one tells them that’s the case, they’ll keep fighting in quicksand and elevate their pulse with their bloodstream filled with venom… or, well, cortisol.
That’s a positive feedback loop and the hole they dug gets deeper and deeper.
– Messing things up at work when trying to work gets infuriating. Anxiety!
– Wants to perform but needs to sleep three hours in the middle of the day, gets anxiety because it took so long – gets stressed and tries to achieve more to calm down/make it better, which increases stress levels.
– Pain hinders activities and taking care of and being with family and might kill sex drive entirely – bad conscience, anxiety, and depression lead to more pain.
– Long-term stress turns into anxiety which turns into panic attacks, where they might make everyday things like shopping, going to the movies, traveling, or driving a car dreadful. Social isolation because human interaction drains too much energy. The energy that isn’t there anymore. Another negative spiral, since we’re quite social creatures. Anxiety can cost tremendous amounts of energy and quality of life, turn into depression and lead to quite large amounts of physical pain.
– A big enough stress response can quickly cause sleep disturbances, and physical pain sure doesn’t help get a good night’s sleep. Anxiety about the future, how, when, and if things ever get better could be parts of it. Suppose you’ve been robbed of all your capacity, which is everything you once held dear earlier – and you have no idea how to get it back again. In that case, your value as a human probably feels kind of low, lying there alone in the dark, exhausted, but with your eyes wide open.
The approach is… quite broad, going from physiotherapy, manual therapy, and pain science to food, behaviors, social life on all planes, physiology, psychology, neuroscience, pharmaceuticals, and… probably a bunch of other stuff if that’s necessary with the common theme of getting you better.