Biopsychosocial Flashcards
What is the Biopsychosocial model of healthcare?
The biopsychosocial model is a method of understanding health and illness through biological, psychological, and social factors. The principle of the biopsychosocial model states that all issues relating to health are products of a complex interplay of these three factors. The model has been both revered and criticized in medical circles.
The BPS is the modal of choice for chiropractic care. Emphasis is placed on
treating the patient as an individual.
The BPS model has been met with both acclaim and criticism.
In a biopsychosocial model great emphasis is placed on self-management of pain,
cognitive and behavioural interventions.
What is the biological influence of the Biopsychosocial model of healthcare?
Biological influence plays a key role in the biopsychosocial, or BPS, model. In this aspect of the model, the physiological causes of an illness are identified and studied. The theories behind the BPS model, however, view biological factors as only one part of illness and that no illness manifests itself based solely on physiological grounds. It must work in conjunction with other deciding features
What is the Psychological influence of the Biopsychosocial model of healthcare?
Psychological influence is another of these chief features. Under this aspect of the model, a healthcare provider will look for underlying psychological issues that
contributed to the development of the patient’s condition. There are a variety of psychological influences that can contribute to an illness, including depression,
negative thought patterns, and a lack of self-control.
What is the social influence of the Biopsychosocial model of healthcare?
The social influence aspect of the BPS model examines the illness from a sociological perspective. Engel deduced that considerations such as economic standing, religion, and even technology can play pivotal roles in the creation of
disease. Personal belief systems are also thought to be of significant importance in the development of illness
What are negative feedback cycles?
Pain sensations (Sensory) often result in decreased physical activity (Behaviour).Decreased physical activities can create feelings of depression (Emotional) anddecreased self-worth (Mental). The depression can lead to decreased motivation
and even less activity (Actions) and increased sensitivity to pain (Sensory).Decreased activity leads to decreased interaction with other people (Social),leads to even more depression (Emotional), and so on
What are positive feedback cycles?
A positive attitude to illness and pain (Mental) can have positive effects on mood(Emotional) leads to greater activity (Behaviour) and greater interest in socialinteractions (Social). All these positively impact on the sensation of pain
(Sensory) which in turn increases your perception of your ability to cope with the pain (Mental), and so on
What are the sensory factors with regards to The Biopsychosocial Model related to chiropractic care?
Physical sensations, which make up the experience of pain
1) Location – the area on the body where the pain is experienced
2) Intensity - ranging from mild to excruciating
3) Nature - the qualitative nature of the sensations (e.g., dull, aching, sharp,
burning, stabbing)
4) Frequency / duration - how the sensations vary over time
Examine the patient for any evidence of physical pathology, in particular
looking out for red flags or indications of serious pathology that would require
immediate referral.
Measure the pain intensity (through use of VAS visual analogue scale and pain
diagrams and questionnaires e.g. McGills pain questionnaire).
Treat any physical pathology that is in your scope of treating by using
manipulation.
What are the emotional factors with regards to The Biopsychosocial Model related to chiropractic care?
The emotional states, which accompany the experience of pain, as well as the
effects of pain on your life; fear, anxiety, depression, despair, guilt, anger, and
irritability.
Identify any yellow flags (fear, anxiety or depression) during history taking and
possibly through the use of questionnaires (such as the Care Response,
Oswestry and Vernon Mior disability questionnaires).
Be aware of your emotional influence over the patient, and any signs of
transference / counter transference.
Advise regarding available support groups or counselling.
Look for indications of the patient seeking companionship or emotional support.
What are the Cognitive (cognitive processes relating to the pain) with regards to The Biopsychosocial Model related to chiropractic care?
Cognitive (cognitive processes relating to the pain)
Awareness of pain, experience and memories of pain, expectations regarding the
painful condition, treatment, and the ability to cope with it. It also includes
thoughts, attitudes and perceptions of life events and the decision making
process.
Be aware of the patient’s perception of his/her condition, their expectations
with regarding their progress in recovery. Be aware of any negative attitudes
that might inhibit recovery.
Make the patient aware of all the facts, being open and honest and supplying
the appropriate amount and level of information.
Involve the patient in the decision-making process, giving them control over
their condition.
Look for any other yellow flags and form strategies for dealing with them.
Check the patients coping strategies. Patients need to be taught that their
condition can be self-managed “hurt does not equal harm”.
What are the behavioural/actions with regards to The Biopsychosocial Model related to chiropractic care?
This includes your responses to the pain, and the effects on your lifestyle
During the Case History taking, gather information on the patient’s activities
- social, occupational, degree of exercise.
Prolonged time off from work reduces the probability of return to work
The best course for reducing back pain disability would be early intervention
and rapid return to work
It has been suggested that in some cases bed rest longer than two days is
counterproductive. Gentle activity is often beneficial.
Look for evidence of fear avoidance behaviour, and illness behaviour
What is fear avoidance behaviour?
Psychiatric model that describes how individuals develop chronic
musculoskeletal pain as a result of avoidant behaviour based on fear.
* Introduced by Lethem et al. in 1983, this model helped explain how individuals
experience pain despite the absence of pathology.
* Avoidant behaviour is healthy when encouraging the individual to avoid
stressing injuries and permitting them to heal.
* However, it is harmful when discouraging the individual from activity after the
injury is healed. The resulting hypervigilance and disability restricts normal
use of the tissue and deteriorates the individual physically and mentally
Fear avoidance behaviour has been identified as one of the most important
cognitive - behavioural dimensions in chronic low back pain, and an important
indicator of disability. As chiropractors we must be aware of this aspect of
patient care.
* Operant-conditioning therapy is useful to decrease fear-avoidance behaviour.
Patients are gradually exposed to perceived painful activities with a
progressively greater duration, intensity and frequency of exercise, with the
focus on reducing the anxiety and pain expectations associated with that
exercise.
* Patients should be advised to resume normal activities safely and within
moderation and gradually increase their physical activities with the aim of
staying as active as possible.
* Should patients need to modify the way they perform any of their activities,
they should be educated on how to do this
How does the physical environment contribute with regards to The Biopsychosocial Model related to chiropractic care?
Includes aspects of the physical environment, which affect your awareness of
pain or ability to cope with pain (weather, housing conditions, furniture,
availability of money and other material resources, means of transportation.)
* Make any recommendations as necessary for altering the height, use of
furniture or equipment in their physical environment at work or home. Eg car
seat position when driving, or computer set up at home.
* Recommend purchasing a firmer bed, or placing a pillow between the
patients legs whilst sleeping.
* Suggest using a cushion in the back of the seat while sitting on a soft sofa
etc.
What social aspects could affect a patient with regards to The Biopsychosocial Model related to chiropractic care?
This refers to all individuals who can affect and who are affected by your pain
condition. (E.g. family, friends, healthcare providers)
* Make the patient aware of the importance of continuing normal activities,
which includes all social interactions.
* Look out for indications of social isolation that may lead to or be as a result
of depression, or other emotional problems. (Yellow flags)
* Ask about social support for family and friends, and about interactions with
other healthcare members.
* If they are receiving treatment for the same or related condition from
another healthcare professional, it may be beneficial to contact that
individual with the patients’ consent and attempt to structure a more
multidisciplinary approach to the treatment process.
What are red flags?
Red flags are signs and symptoms, clinical indicators of possible serious underlying
condition requiring immediate medical intervention.
* Fever of 38ºC (100.4ºF) or above
* Unexplained weight loss
* History of cancer
* Abdominal bruit (AAA)
* Swelling of the back
* Signs / symptoms of infection
* Constant back pain that does not ease after lying down
* Pain in your chest or high up in your back
* Pain down your legs and below the knees
* Pain caused by a recent trauma or injury to your back
* Loss of bladder / bowel control
* Inability or difficulty passing urine
* Perineal numbness, numbness around your genitals, buttocks or back passage
* Pain that is worse at night
* Unable to reduce symptoms mechanically
* History of trauma (mild + osteopaenia)
* Family hx inflammatory arthropathy
An example of a red flag is cauda equina syndrome, what is it?
Cauda Equina Syndrome
Cauda equina syndrome is compression of the central tube of nerves below the lower
end of the spinal cord (usually L1) including compression of the nerves to the bladder
and bowel.
This is an emergency because the nerves to the bladder and bowel are very sensitive
and once compressed and producing symptoms, permanent damage may result if they
are not decompressed urgently. The long term results for bladder and bowel function
are worse if the nerves are decompressed more than 48 hours after the onset of
bladder and bowel symptoms.
Typical symptoms include:
* Low back pain
* Bilateral leg pain
* Perianal sensory loss; altered sensation around the back passage and genitals.
* Bladder symptoms include: loss of bladder sensation, abnormal sensation on
passing urine, urinary retention (more common in men), urinary incontinence (more
common in women).
* Bowel symptoms are rare but include incontinence.
* Sexual / erectile dysfunction
* Progressive weakness in the legs
