Spine Update

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Abstract
Spine Update on the biopsychosocial model. To review and discuss the strengths and weaknesses of the application of the model to spine care. The biopsychosocial model of illness has had (and will continue to have) a significant impact on spine care. It has changed-in a positive way-the ways in which view spinal disease, treat patients, and assess outcomes. To date, however, little discussion has taken place regarding concerns over its implementation. Using texts covering the general theory of the biopsychosocial model and the literature as the model is applied to spine care, a review was undertaken, evaluating the strengths and weaknesses of the theory's application to our field. Just as the biomedical model allowed, and continues to allow, significant medical advances via the objective study of pathoanatomic disease; the biopsychosocial model has afforded similar advances by placing the disease back into the patient and emphasizing illness experienced within the patient's unique biologic, psychological, social, and economic milieu. Thus, the strength of the model is its service as a clear reminder that clinical decisions about how to manage a patient with persistent low back pain living in difficult social conditions are more complex than those for patients who are not. Concerns regarding the model, however, are real and include its application as the primary mode to assess outcomes with a blind eye toward other potential factors; the medical/historical tendency to overweight psychosocial factors when underlying pathology is not clearly defined; whether or not the theory underlying the model is falsifiable/scientific; whether it affords explanatory or predictive power; whether its implementation improves outcomes; and whether it contributes to the "medicalization" of patients with back pain. The biopsychosocial model has been readily adapted to all aspects of spine care with many positive implications. There are, however, some concerns and negative implications and awareness of these should afford a better appreciation of when and where the model can be most usefully applied.