Understanding the complexity of pain

Pain is a universal experience that affects millions of people worldwide. Whether it is a mild headache or a disabling chronic condition, pain can manifest in many ways and have a significant impact on quality of life.

To better understand this complex phenomenon, many healthcare professionals have adopted the biopsychosocial model of pain, a comprehensive approach that takes into account the biological, psychological, and social dimensions of each individual.

According to the International Association for the Study of Pain (IASP), pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

In the updated 2020 definition, several key points stand out:

• Sensory and emotional experience: pain is not purely physical; it also involves emotions such as fear, anxiety, and distress.
• Unpleasant: pain is perceived as aversive or uncomfortable, often associated with suffering.
• Actual or potential tissue damage: pain may arise from real injury or disease, but can also exist without any detectable tissue lesion.

This definition acknowledges the subjective and multidimensional nature of pain and is widely accepted in the medical and scientific communities as a framework for understanding and assessing it.

The IASP further specifies:

“Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.”

This statement lays the foundation for the biopsychosocial model.

The biopsychosocial model is a holistic approach recognizing that pain is not simply a physical reaction to injury or illness. It results from the interaction between biological, psychological, and social factors unique to each person.

This model contrasts with the traditional biomedical model, which focuses solely on biological causes and views symptoms as direct indicators of disease, without considering the individual’s overall context.

This dimension focuses on the physiological, neurobiological, and genetic processes involved in pain. It includes the activity of the central and peripheral nervous systems and the mechanisms of pain transmission and perception.

Understanding the biology of pain is essential for developing effective treatments — but it represents only one piece of the puzzle.

The psychological component acknowledges the role of emotional and cognitive factors in shaping pain perception. Anxiety, depression, stress, and personal beliefs can modulate how pain is experienced and managed.

Psychotherapy, cognitive-behavioral therapy (CBT), and other psychological interventions can be highly effective in helping patients regain control and improve their well-being.

The social dimension addresses the influence of one’s environment — family, culture, work, support networks, and socioeconomic status — on the experience of pain.

Involving family and community in the care process can significantly improve outcomes and enhance quality of life.

Adopting the biopsychosocial model in clinical practice has far-reaching implications. Healthcare professionals must assess and treat not only the physical aspects of pain but also its emotional, cognitive, and social dimensions.

This often requires a multidisciplinary approach, involving physicians, psychologists, osteopaths, physiotherapists, social workers, and other health professionals.

Consider Flora, a young florist. One morning, as she bent down to pick up a toothbrush she had dropped, she felt a sudden sharp pain in her lower back. The pain was so intense that she was immobilized on the floor for nearly an hour before she could get up again.

Since then, she has been unable to stand upright or find a comfortable position. Panic sets in, as she recalls that her father took over a year to recover from a lumbar disc surgery. Flora cannot afford such a setback — she has just opened her shop with a bank loan and already faces financial pressure.

This isn’t her first episode. The last one occurred more than a year ago, but imaging tests at that time revealed nothing significant.

Is it realistic to think that Flora seriously injured herself by simply bending over to pick up a toothbrush?

A medical diagnosis is, of course, essential, but in most cases (about 90% of chronic low back pain), the pain is non-specific, meaning it’s not caused by inflammation, trauma, tumor, or infection.

So why does she feel such intense pain this time?

Because in low back pain, psychosocial factors are often stronger predictors of chronicity than biological ones.

Flora’s situation includes several aggravating elements:

• stress from opening her business,
• financial anxiety,
• accumulated fatigue,
• lack of physical activity,
• fear of having a “weak back” like her father.

Her alarm system is in a state of hypervigilance. A harmless movement is interpreted by the brain as a threat, triggering intense pain.

In this context, pain is not merely a biological warning signal but also a brain-generated interpretation. Flora’s brain perceives imminent danger and responds with painful muscle contraction to protect the perceived vulnerable area.

Back pain is often seen as structural weakness, fostering fear of movement and avoidance behaviors. This creates a vicious cycle that perpetuates pain and disability.

If the therapist focuses only on mechanical relief (for instance, reducing muscle tension) while reinforcing the idea of fragility, recurrence becomes likely.

An effective approach must instead rely on:

• pain education, explaining real mechanisms,
• challenging limiting beliefs,
• gradual re-exposure to movement,
• multidisciplinary care integrating psychological and social aspects.

This empowers patients to break the cycle of pain, fear, and avoidance, and to rebuild confidence in their bodies.

The biopsychosocial model of pain provides a holistic understanding that acknowledges pain as a complex, multifaceted experience.

By transforming the patient-therapist relationship into a collaborative partnership, this approach promotes personalized and effective care. Every patient is seen as a whole person — with unique beliefs, emotions, experiences, and environments — enabling truly patient-centered treatment.

At Aliantis, this philosophy guides our practice. We believe that to relieve pain sustainably, one must address all its dimensions: biological, psychological, and social.

Recognizing the complexity of pain is giving the patient back their rightful place in the healing process.

This blog article is not intended to generate new knowledge; its writing is based on the review of scientific publications, blog articles, and other writings.