Pain: A Biopsychosocial Concept

Pain A Biopsychosocial Concept

Pain: A Biopsychosocial Concept

Quite often, pain is the primary reason patients seek care with a physical therapist. Pain is a prevalent and often unpleasant sensation. Pain can lead to anxiety, fear, decreased mobility, and worse, yet, depression and complete disruption of life. Patients often question why their pain continues to linger, even when months have passed after an event or an injury. Zooming out and looking at the big picture can help answer this question, although the answer isn’t necessarily easy. Pain researchers devote their lives to researching about pain, with the hopes of providing a means for patients and providers to better understand pain and the biological processes that occurs within pain states. The Neuro Orthopedic Institute (NOI) is a group of researchers who have special interest in a biopsychosocial approach to pain, more specifically the merging of the biology of human pain, stress and performance with the psychological and social environment1. In other words, our nervous systems are the primary reason why we feel pain and the assessment and management of the nervous system and brain – particularly how the brain is wired to our body and any changes that can occur within the brain as we move through pain cycles and/or rehabilitation – is an important focus of their research. Here are a few take home points that the NOIsters have been encouraging providers (especially PTs) to have open dialogue on when it comes to pain, whether it’s persistent or acute.

  1. It’s worthy to state a simple fact up front: pain is REAL. Don’t let anyone tell you otherwise.
  2. Explaining pain to people means teaching people about the biological processes underpinning pain. In other words, peoples’ pain is real and there are true biological processes at work when pain is present, whether it’s been two weeks or two years.
  3. Pain is conceptualized in the brain, just like vision, hearing, smelling, and other senses. The saying goes ‘No brain, no pain!’. While all pain is real, lucky for us pain does not necessarily mean tissue damage or recurrent injury. Pain can be overprotective, and often is in the case of persistent pain.
  4. This overprotection causes alarm signals to go off. When the alarm system sounds, then other alarms go off too, creating a nervous system that goes into a repeated cycle of hyper-alertness and over-protection (think: fight or flight response). Your body is simply doing what it knows how to do but all too commonly, it ends up being too much of a good thing. (And, yes, that was a reference noting that pain can be a good thing! Keep reading…)
  5. Pain? A good thing? It sure can be. It helps alert us if something within our biological system is a little off or if there’s truly danger. With that being said, the intensity of pain is not necessarily 1:1 ratio with extent of tissue damage or even danger. This is when providers like PTs step in and help explain why certain pain symptoms are present as well as examine for any red flag signs that would warrant a visit to the doctor. 
  6. Explaining pain and the interaction of various pillars – social, environmental, biological, and psychological – that influence pain can be helpful during rehabilitation. After all, “No pain, no gain” doesn’t apply… but “Know your pain, know your gain” does. It’s helpful to consider all the reasons why, on a daily basis, pain levels may fluctuate. The way our bodies interact with our brains and even more broadly, the way our brain and body together interact with the world around us is no small consideration. This is why we thank the NOIsters for their amazing dedication to the world of pain!

What do you do if pain is stopping you in your tracks? Schedule with one of our PTs today! We will help you work with your pain to get you back on your feet again! 




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Covid-19 Notice

11/15/2020 Covid-19 Notice:

For the past 5+ months we have safely operated under our Covid-19 Exposure Control, Mitigation and Recovery Plan. This has allowed us to continue caring for our community and helping our clients return to the activities they love! As King County and all of Washington State are facing the third wave of Covid-19 cases, we remain open and committed to keeping you moving while also lessening the load on our primary care offices, urgent care clinics and emergency rooms. Our PT team is available for both in-clinic and virtual physical therapy visits and Pilates sessions. This allows us to comply with Governor Jay Inslee's Covid-19 Guidance on 11/15/2020, while also meeting our obligation as essential infrastructure workers. For in-clinic treatment/Pilates sessions, the PT will wear a mask and the client needs to wear a mask of their own. Social distancing is observed throughout the clinic and rigorous cleaning guidelines are followed. At times during your PT treatment, it may not be possible for your PT to observe social distancing, such as during certain manual therapy techniques. The need for in-clinic treatment vs. virtual or telehealth treatment will be a joint determination between you and your PT. You may review our Covid-19 Exposure Control, Mitigation and Recovery Plan for the details of how we provide safe, in-person care.

If you are seeing your extended family indoors or traveling via plane during the Thanksgiving holiday, we ask that you inform your PT so that we may switch your visits to telehealth for 14 days after these holiday exposures. Thank you for understanding that this policy is in place to allow us to meet our responsibility to all clients, which is to do no harm.

We remain passionate about helping you improve and maintain the function of your movement system so that you can do the activities you love. We invite you to follow/Like our Facebook page, where I am offering complimentary weekly Pilates mat class on Wednesdays at 7am. All are welcome to participate in these classes or view them anytime on our Facebook page.

Please contact me directly with any questions or concerns. I am available via clinic phone (206-535-7356) and email ( We will update you here and our Facebook page as things change.

Thank you for your support of this small, locally-owned physical therapy private practice!

Elizabeth Rogers, PT

Owner, Elizabeth Rogers Pilates & Physical Therapy, PLLC