The Direction
"There appears a light on the ocean of sorrow, suffering and pain... ...which brings new hope, Pleasure and comforting gain."

~ Dr.P.S Ajrawat

Biopsychosocial Model

As a qualified pain specialist, and as a pioneer in the field of Pain Management and Pain Medicine, one of my goals is to make the public and the professionals aware of the new frame of reference and the methods in terms of evaluating and treating pain. The biomedical model, which is also known as dualistic model, has been prevalent in terms of understanding and treating pain up to this day. This model considers Mind and Body as two separate entities, and when there is aproblem of Pain, there is a tendency to rule out one against the other.

The history of chronic pain patients commonly reveal's that there has been excessive and unnecessary over-utilization of various diagnostics and invasive procedures in order to prove the somatic cause of pain. This is not only unproductive but also detrimental to the relief of pain. This approach and lack of identifiable source of pain leads to a faulty conclusion that patient's pain is all in the Head or in other words Unreal. This conclusion leaves pain patient frustrated, angry and depressed. Hence biomedical or dualistic approach adds to iatrogenic morbidity and pain and cause pain to become chronic. The patient becomes unwilling rider on the never ending Merry-Go-Round forever in search of pain relief.. So how do we plan to change this old obsolete method of understanding and treating pain?

The new, effective and up-to-date model to treat pain is called the Biopsychosocial Model of Illness, which is based on the general systems theory established by some pioneers in the field of Pain Medicine/Pain Management. According to this model, there are multiple system levels starting from a subcellular level to an organ, organ system level with a complex organization within the human body. It relates to the mind as well as the outside of the body: that is, to the environment, society, family, culture , work etc.which communicates with each other with bidirectional feedback. So failure of the defense mechanism and disturbance at one or many levels will result in disturbance at other levels. If there are any changes, for example in the environment or the psychosocial, it will not only effect the mind and the brain but it will also effect the body as such.

A typical example will be working in a psychologically stressful environment or in an environment where there is a repetitive physical or mental trauma. Common examples are patients with headaches, arthritis, stomach ulcers, etc. The other examples are patients who were psychologically well adjusted but after sustaining an automobile injury or other type of truma will not not only suffer from pain but in the due course will also become depressed. Once the patient becomes depressed, it effects the patient's entire life, that is, the personal, family, and work situation, and other important events in ones life. So any kind of stimulus or trauma, may it be mechanical or chemical or toxic or psychological can result in illness and can involve both mind and body as well as other factors.

In order to treat pain effectively one has to understand and evaluate the various levels and components which are involved in producing the pain and pain associated stress. In contrast, the biomedical model tends to ignore the psychosocial component and focuses only on the somatic component. Then, if the pain cannot be located in something obvious, such as a broken bone or torn ligament, the traditional physician may even decide that the pain is 'unreal.' This is not only incorrect but very insulting to the pain patient who puts his or her trust in the health care professional in search of pain relief. As we enter the twenty-first century, it is time to go forward and make a scientific and positive effort to conquer pain with a determination which leads us to a better and pain free world.

Management of various PAIN DISORDERS is done emphasizing the importance of:

  • Empathy
  • Concreteness of Diagnosis
  • Use of Multimodality Treatment
  • Close Follow-Ups
  • Use of Non-Narcotic and Non-Addicting Pain Medication
  • Patient Cooperation, Compliance and Active Participation in the Treatment Plan