Background: Though there is wide support for the application of biopsychosocial perspectives in
clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate
training or attitudes favoring a biomedical approach. Recent research has indicated that despite such
explanations, both established general practitioners (GP) and medical students account for some
psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being
likely to apply these in real-world, clinical settings due to numerous factors, including available time with
patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the
factors that affect application of these processes is required, particularly regarding chronic pain.
Objectives: The aims of the current study were to investigate medical students’ conceptualizations
of the factors that influence application of a biopsychosocial approach to clinical judgement-making in
cases of chronic pain using interactive management (IM), model the relationships among these factors,
and make recommendations to chronic pain treatment policy in light of the findings.
Study Design: The current study used IM to identify and model factors that influence the application
of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical
students’ conceptualizations of these factors.
Setting: Two university classrooms.
Methods: IM is a systems thinking and action mapping strategy used to aid groups in developing
outcomes regarding complex issues, through integrating contributions from individuals with diverse
views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive
structural modeling, which in this context were employed to help medical students identify, clarify, and
model influences on the application of biopsychosocial perspectives in treating chronic pain patients.
Results: Results of IM group work revealed 7 core biopsychosocial approach application categories:
GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patient
perception. GP attitudes was the most critical driver of all other competencies in the system, with cost
and GP knowledge revealed as secondary drivers.
Limitations: Potential differences in level of prior biopsychosocial perspective knowledge across
participants and a potentially small sample size (though consistent with past research and appropriate for
an exploratory study of this nature – for purposes of achieving the depth and richness of the deliberation
and qualitative insights revealed by participants using the IM methodology).
Conclusions: Results from this study may be used to both recommend further research on the
identified factors influencing application of biopsychosocial perspectives in treatment of chronic pain
and support amendment to extant health care policy, particularly with respect to cost, GP attitudes, and
knowledge. Though this research claims neither that the influences identified are the only influences on
biopsychosocial application, nor the order of their importance, the research does contribute to an ongoing effort to better understand the factors that influence doctors in their treatment of chronic pain.
The biopsychosocial approach to chronic pain: Scientific advances and future directions.
