Operationalizing Pain Treatment in the Biopsychosocial Model: Take a Daily “SWEM”—Socialize, Work, Exercise, Meditate

Abstract

In the United States, chronic pain is often poorly treated at an exceedingly high cost. The use of the biomedical model to manage pain is frequently ineffective, and evidence suggests that the biopsychosocial (BPS) model is a better choice. A problem with the BPS model is that it has not been operationalized in terms of patient behavior. This commentary addresses that issue by suggesting that people with chronic pain and illness participate daily in four self-management health behaviors: socialize, work, exercise, and meditation, and discusses evidence that supports these recommendations. These self-management behaviors may decrease pain and thus reduce the need for pain medications and other medical interventions. Additional topics include patient adherence and health coaching.

Stopping or Decreasing Opioid Therapy in Patients on Chronic Opioid Therapy

“…Patients may be referred to a pain specialist, addiction expert, psychologist, psychiatrist, or other counselor to help navigate the transition away from opioids and toward other pain relief. Patients may also benefit from referrals to physical or occupational therapists; some patients at this point may be receptive to exploring nonpharmacological pain control strategies, such as meditation [21, 22].…”

Achilles Tendinopathy and the 100-Pound Punching Bag

“…Exercise is an appropriate intervention for people with a variety of chronic illnesses, both physical and mental [5][6][7][8], and it can be more effective than medical treatment [5,7]. Low back and neuropathic pain respond well to exercise and that includes training on a treadmill and running [8][9][10][11][12].…”

Chronic Pain Patient “Advocates” and Their Focus on Opiophilia: Barking Up the Wrong Tree?

“…Numerous others with broader understandings of pain management have subsequently echoed his sentiments. [14][15][16][17][18] The importance of providing chronic pain patients with education in order to help them reconceptualize their pain away from flawed biomedical approaches has also been addressed in the literature. 19,20 Accordingly, we posit that advocating solely for access to opioid analgesia is in fact advocating for ineffective, purely biomedical care, as opposed to coordinated interdisciplinary treatment that is likely to be far more beneficial for most patients.Second, the image of patients with chronic pain (as well as that of many of us who treat them) is less than stellar at this juncture.…”