Interventional pain medicine: retreat from the biopsychosocial model of pain.
The field of pain medicine has shifted from multidisciplinary rehabilitation to procedure-focused interventional pain medicine (IPM). Considerable controversy exists regarding the efficacy of IPM and its more narrow focus on nociception as an exclusive target of pain treatment. This topical review aims to examine pain research and treatment outcome studies that support a biopsychosocial model of pain, and to critique the clinical practice of IPM given its departure from the premises of a biopsychosocial model. A modern definition of pain and findings from clinical and basic science studies indicate that pain-related psychological factors are integral to pain perception. The clinical viability of IPM is challenged based upon its biomedical view of peripheral nociception as a primary source of pain and the potential of this viewpoint to foster maladaptive pain attributions and discourage the use of pain coping strategies among chronic pain patients. IPM should adopt a biopsychosocial perspective on pain and operate within a framework of multidisciplinary pain rehabilitation to improve its effectiveness.
Department of Physical Medicine & Rehabilitation, University of Michigan Health System, 325 E. Eisenhower Pkwy, Ann Arbor, MI 48108 USA ; Department of Physical Medicine & Rehabilitation, Ann Arbor Veterans Health Care System, Ann Arbor, MI 48105 USA.
Randy S
RS
Roth
Michael E
ME
Geisser
David A
DA
Williams
Biopsychosocial model; Chronic pain; Interventional pain medicine; Multidisciplinary pain rehabilitation; Psychosocial factors in pain