Pain as a whole person experience – embracing biopsychosocial clinical reasoning

This narrative review focuses on published work that has explored and applied a biopsychosocial conceptualisation of pain. Biomedical or pathoanatomical approaches to pain are inadequate, failing to explain the inter–individual variability in response to noxious stimuli, the inconsistent relationship between pain and tissue health and the large numbers of people with pain without an attributable pathology. Pain is biopsychosocial in nature and health professionals need to adopt more sophisticated strategies for clinical reasoning to improve pain assessment and management. Instead of a direct link to pain and tissue injury, it has been proposed that pain is responding to a need state, related to tissue injury and recovery. Recognising research that links life experiences of adversity to pain vulnerability, the review offers a reinterpretation of this proposition and critically evaluates the commonly used dichotomy of acute versus chronic pain. Finally, a summary of clinical reasoning tools is presented to support a biopsychosocial way of thinking and practicing, with a trauma–informed strategy to emphasise the need for early, appropriate and targeted intervention, to avoid unnecessary pain–related suffering and disability.