THE BACK PAGE RESEARCH REVIEW Biopsychosocial aspect of pain REVIEWED BY SHAWN THISTLE technique intended to target behav-ioural changes. It focuses on a pa-tient-centered discussion to identify motivators and barriers to change. This technique is based on four principles: expressing empathy; developing dis-crepancy between what needs to occur for positive change and what the pa-tient is willing to do; “rolling with re-sistance” if the patient expresses nega-tivity, and; supporting the patient’s self-efficacy so the patient understands the doctor is ready to support him/her when s/he is ready to make change. Cognitive behavioural therapy is an approach that focuses on the relation-ship between thoughts, emotions and behaviours. It attempts to nurture the patient’s development and use of active problem-solving skills to assist him/her in managing the challenges associated with chronic pain. Acceptance and commitment ther-apy intends to help a patient shift his/ her perspective in order to deal posi-tively with experiences. It aims to change problematic thoughts and feelings to constructive alternatives such as acceptance, mindfulness, cognitive defusion, and committed action. T STUDY TITLE: The biopsychosocial model and chiropractic: A commentary with recommen-dations for the chiropractic profession AUTHORS: Gliedt JA, Schneider MJ, Evans MW et al. PUBLICATION INFORMATION: Chiropractic & Manual Therapies 2017; 25: 16. he biopsychosocial (BPS) model proposes examining patients from a lens that incorporates the biological (physical or chemical alter-ations) and psychological (mental health and personal factors), in the context of the social determinants of health for each individual. The purpose of this commentary was to summarize the BPS model and pro-vide the authors’ recommendations for integrating it into chiropractic educa-tion and practice. Chiropractors and other manual medicine providers are well suited to engage in positive psychosocial inter-ventions, which may help to reduce the risk of developing chronic pain and disability. Clinicians may assist patients with the development of active coping techniques by encouraging positive thinking, helping patients learn to re-direct negative self-thoughts, engage in activities which distract from pain and continue with physical activity within pacing parameters. As a recent example, Monticone et al. conducted a RCT to examine the effect of group-based rehabilitation with cognitive behavioural therapy (CBT) compared to general physio-therapy exercises in patients with chronic neck pain. Following treatment and at 12-month follow-up, the rehab and CBT group showed a reduction in kinesiophobia and catastrophizing. In another important example, the clinical guidelines recently published by the American College of Physicians recommend interventions such as mindfulness-based stress reduction, progressive relaxation, CBT, exercise, yoga, tai chi, manipulation and rehabil-itation as initial treatment options for patients with acute, subacute and chronic low back pain. It is important to recognize that cli-nicians may inadvertently justify a pa-tient’s maladaptive thoughts and beliefs if messages overemphasize pathoanat-omy or the need for indefinite, long-term, passive care. If the patient per-ceives that missing appointments will result in the worsening or persistence of their condition, they may become reliant on passive care, lose a sense of self-efficacy and believe s/he has no control over her/his health. Clinicians should be aware of the potentially neg-ative consequences of their words, and aim to frame messages in a positive light that emphasizes the benefits and gains of treatment. Techniques such as motivational interviewing, CBT and acceptance and commitment therapy can serve as doc-tor-patient communication strategies to identify targeted behavioural changes, and understand a patient’s motivations and barriers to making change. These techniques assist pa-tients in the development of construc-tive alternatives to problematic thoughts. Motivational interviewing is a Applications, conclusions DR. SHAWN THISTLE is the founder and CEO of RRS Education, providing weekly research reviews, online courses and seminars to help busy clinicians integrate current research evidence rationally into practice. For more information, visit: www.rrseducation.com. Shawn can be reached by email at [email protected] 30 Canadian Chiropractor April 2018 The authors recommend that clinical communications should focus on max-imizing positive messages to foster self-efficacy and self-reliance, while minimizing negative communication that encourages reliance on passive care. The authors further suggest that research regarding the implementation of the BPS model in practice is re-quired, along with research investigat-ing outcomes of BPS and integrated care. Finally, the authors recommend increased emphasis of the BPS model in chiropractic education and continu-ing education courses. www.canadianchiropractor.ca
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