General Guideline Principles for Biomedical vs. Biopsychosocial

Approaches to the Diagnosis, Treatment and Management of

Pain for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Biomedical vs. Biopsychosocial Approaches to the Diagnosis, Treatment and Management of Pain.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Biomedical vs. Biopsychosocial Approaches to the Diagnosis, Treatment and Management of Non-Acute Pain

When it comes to describing pain, orthodox biomedicine “assumes illness to be completely considered for by variation from the norm of observable biological (somatic) variables” (Engel 1977). Thus, the existence and severity of a symptom are always directly causally related to a particular pathophysiologic event.

While the medical community has used this paradigm successfully to treat and cure some diseases (such as infectious diseases), it has often failed to address non-acute illnesses, such as chronic pain. For instance, there has been a method to locate the “pain producer” and eliminate it by trimming it out or hindering it for decades.

It is increasingly recognized that the traditional biological method of comprehending and treating pain is insufficient. Its sole use may lead to patients and doctors having inflated expectations, insufficient pain relief, and severe impairment in individuals who have pain that lingers long after the initial injury has healed.

By seeing pain and condition as a complex interaction of biological, psychological, and social elements that can be easily examined, Engel’s biopsychosocial model, first presented in 1977, places more emphasis on the patient than on assumed pathology.

This method acknowledges that pathophysiology, psychological state, cultural background, belief system, and interactions with the environment all contribute to the development of pain (Disability system, home, health care providers and workplace).

The following table contrasts these two pain models (Hanson and Gerber 1993):

Table 1: Pain Models

Linton found compelling evidence that psychosocial factors are highly associated with the change from acute to chronic pain impairment and that they often have a greater influence on back pain disability than biological or biomechanical factors (Linton 2000).

Therefore, the physician should always be ready to treat psychosocial factors in a collaborative, multidisciplinary approach when clinical improvement is insufficient.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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