Recently i've been thinking about how the rise of pain science has influenced our views and understanding of pain. While pain science is definitely a step forward from the biomedical model, combining pain science with the BPS model might still have some challenges in practice. 1/

For many clinicians the understanding of pain science might lead to putting the persons pain in the center of the BPS model and thereby focussing on which factors, that might influence the persons pain experience (i.e. descending modulation). 2/

While this is an important step, it also causes a risk for clinicians to become reductionists in their clinical reasoning, and separate the biopsychosocial model into bio + psycho + social drivers or risk factors for a persons pain experience. 3/

By taking this approach we might miss the important fact, that many factors related to a persons pain experience might be inter-related as well. For example i recently had a patient with persistent pain, who also had ADHD, trouble sleeping and were physically inactive. 4/

Looking at these factors as isolated drivers or risk factors, there is no doubt these might be relevant to the persons pain experience. However, in this case the person were used to self-medicate her restlessness from ADHD with a high level of physical activity. 5/

Because of her pain she had started to avoid physically activity. The inactivity led to an increase in restlessness and problem sleeping at night. The waken hours at night led to an increase in catastrophic thoughts, bad mood and less energy the following day. 6/

The isolated drivers or risk factors in this case might therefore not only influence the persons pain experience directly, but also be inter-related factors. In clinical practice this means that it isn't enough to think "Which B+P+S factors might influence this persons pain?" 7/

We might also need to gain insights on "Does these risk factors or drivers affect each other for this person?", "Why does these factors affect each other?" and "Why is this relevant to the person sitting in from of me?". 8/

By asking these question we're able to gain a deeper insight into the persons narrative and lived experience, and by doing this we're in a better position to start making sense of their pain together in a collaborative partnership. 9/

These important insights are only possible for us to get, if we deeply listen to the person in front of us without being judgemental and assume that we already know what "X" means to that person. This is why good communication is fundamental to become a great clinician 10/

Without good communication skills, we might never understand why one becomes "fear-avoidant" or has "low self-efficacy", what this fear or low self-confidence means to that person, and how these factors might influence the persons life and pain experience 11/

The thoughts behind this post is inspired by posts from @CorKinetic - thank you for sharing your thoughts, and encouraging me to reflect on a daily basis!