Jan 24 • Sean Overin

Adopting a Biopsychosocial (BPS) Approach to Pain: What Patients and Clinicians Are Saying

As clinicians, we’ve all heard about the Biopsychosocial (BPS) model of pain. Originally developed by George Engel, it was designed to move beyond the limitations of the biomedical model by incorporating a more holistic understanding of patient care. But how do patients really feel about it? And what challenges do we, as clinicians, face when trying to apply it? 

As the universe often does, it provided this opportunity in my area of interest to participate in a research study. The study explored these very questions, diving into both patient and clinician perspectives on the BPS model. Here’s what I learned and provide some practical tips for incorporating it into your practice.

What Patients Are Saying ...

1. Pain is Complex

Patients appreciated learning that pain isn’t just about tissue damage. It’s a subjective experience shaped by the brain and nervous system. Analogies like the fire alarm or smoke versus steam helped make this concept relatable, especially when explaining an over-sensitive nervous system.

What really resonated with patients was understanding that the nervous system can “learn” pain—and that this learned pain can "unlearned" to improve with movement and behavioral strategies.

This surprised me! I don't often think about pain in terms of the body learning and unlearning but for whatever reason this resonated with this cohort. When I do think about learning, its usually in context of updating our body schemas by coming up with predictions and looking for surprise namely through graded exposure and expectancy violations. More here from Craske et al. 

Validation Remains Important

Patients often expressed that their pain experiences felt dismissed. Before they can fully engage in treatment, they need to feel heard and understood—a theme that consistently appears in the literature and one from this study. 

A word of caution: overemphasizing the brain’s role in pain can backfire. While pain is undeniably influenced by the nervous system, framing it the wrong way can make patients feel like their pain is “all in their head,” leading to unnecessary worry or even self-blame. The way we communicate matters. Poorly chosen words can unintentionally rupture the therapeutic alliance, making progress even harder.

I’ve learned this the hard way. Early in my career, I leaned too much on pain neuroscience education, and I could see the confusion, frustration—or even resistance—from patients. Over time, I’ve refined my approach, balancing validation with education to ensure patients feel acknowledged while still gaining insight into their pain.

Choosing the right language isn’t just a soft skill—it’s a clinical necessity.

Barriers to Good Healthcare

Patients highlighted several barriers to effective care:

- Limited time during appointments.
- A persistent focus on the biomedical model.
- A lack of clinician knowledge about modern pain science.

Many patients said they had to teach themselves about pain and wished their healthcare providers had provided better education. Hopefully one day, we hear less of these!

The BPS Model Brings Hope

For many, learning about the BPS model was empowering. It gave them hope and helped them understand their pain in a new way. But there was also some resistance—patients struggled with the idea that pain isn’t always tied to tissue damage and worried that psychosocial factors might overshadow legitimate physical contributors.

This finding surprised me - despite my willingness to discuss elements beyond just the biological, my mind at times will take a 'deep breath' before gently moving into how the psycho and social parts might be wrapped up in this persons story. This is in part because despite the progress in understanding we see in the literature and in some corners of social media, there is still a biomedical understanding of pain that generation after generation continues to adopt. 

Personalization Matters

This one is evergreen, similar to validation. Patients emphasized the importance of tailoring the approach to their individual needs. This means using clear, relatable language, focusing on their specific goals, and introducing the BPS model at the right time. Cookie-cutter approaches is not what is going to satisfy people with persistent and nor should it be our expectation that it will. 

What are Clinician's Saying

Language Matters

How we talk about pain can make or break the therapeutic relationship. While analogies like the fire alarm are helpful, phrases like “pain is a decision made in the brain” could inadvertently reinforce stigma. The goal is to educate without dismissing the patient’s experience. Match the metaphor to the patient.

Timing

Introducing the BPS model too early can overwhelm some patients. Others might need it right away to make sense of their pain. The key is to personalize your approach based on where the patient is at in their journey. Some folks in pain don't necessarily need to understand the multifactorial nature of pain. 

Addressing Fear

Patients often worry that focusing on psychosocial factors means their pain isn’t being taken seriously. Clinicians mentioned the need to frame these factors as part of the bigger picture, not the sole cause of their pain.

Barriers to Implementation

Clinicians face challenges too—limited time, a biomedical bias in healthcare, and a lack of training in pain science can make adopting the BPS model tough. But these barriers are worth addressing because the model has so much potential to improve care.

Movement First

Both patients and clinicians agreed: movement is essential for managing persistent pain. The challenge is helping patients find safe, manageable ways to move that rebuild their confidence and recalibrate their nervous system. This has been my experience - movement will always play some role in recovery.

Practical Tips

Adopting the BPS model starts with validating the patient’s pain and acknowledging its impact on their life. Validation is a foundational step that builds trust and ensures patients feel heard and understood. Before diving into explanations or strategies, take the time to listen to their concerns and experiences. This not only strengthens the therapeutic relationship but also sets the stage for effective collaboration. 

Using relatable language is key to helping patients understand the complexities of pain. Analogies and stories, such as the fire alarm metaphor, can make pain science more accessible and less intimidating. However, it’s crucial to avoid medical jargon or phrasing that might unintentionally minimize their experience. Thoughtful communication can help patients reframe their understanding of pain while maintaining a sense of validation and respect.  

Personalization is another essential when introducing the BPS model. Cookie cutter approaches, not surprisingly, is not what patient's with chronic pain are after. So what we need todo is meet each patient where they are in their journey, tailoring the approach to their readiness and individual goals. For some, learning about the model early on provides clarity, while others may need more time to process their experience before engaging with the concept. Aligning your explanation with their personal objectives ensures that the model feels relevant and empowering.  

Movement is remains a cornerstone of the BPS approach, and encouraging patients to engage in safe, gradual activity is key to building confidence in their bodies. Small, achievable steps can lead to significant breakthroughs, helping to recalibrate their nervous system and reduce fear associated with movement. This focus on action helps patients shift their mindset from avoidance to progress.  

Finally, instilling hope is one of the most powerful tools in a clinician’s arsenal. Emphasize the adaptability of the nervous system and the potential for improvement over time. By focusing on the possibility of progress rather than limitations, you can help patients feel more optimistic about their journey and motivated to engage in their treatment plan.  Together, these strategies create a patient-centered approach that fosters trust, builds understanding, and supports meaningful change.


Wrapping Up ...

The BPS model requires a thoughtful approach. Patients want validation, clear communication, and actionable strategies. Clinicians need time, training, and tools to meet these needs effectively.

By working together, we can create a modern, empathetic approach to pain management that fosters trust and drives better outcomes. I hope you found something new to reflect on or had a key idea reinforced in your practice.  

Thanks for reading, and I’d love to hear how you’re incorporating the BPS model into your care. Let’s keep the conversation going! #ChronicPain #BPSModel

Sean Overin, MPT, DPT Physiotherapist