In 2011, the Institute of Medicine (IOM) published Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. The report called for a “cultural transformation in the way pain is perceived, judged and treated” and determined that the most immediately important of its sixteen recommendations (Recommendation 2.2) was for the Department of Health and Human Services (HHS) to develop a “comprehensive, population health-level strategy for pain.”
In March 2015, HHS published The National Pain Strategy (NPS) Report in the Federal Register. The Executive Summary includes a set of “fundamental conclusions and implications drawn from the IOM report.” Among those is the statement that:
“Chronic pain is a biopsychosocial condition that often requires integrated, multi-modal, and interdisciplinary treatment, all components of which should be evidence-based.”
For some time, the International Association for the Study of Pain (IASP) has defined pain as a “biopsychosocial” phenomenon, and references to pain as a “biopsychosocial condition” are peppered throughout the IOM report. These efforts are meant to designate pain not simply as a physical sensation or a symptom, but rather as a phenomenon that is experienced by a thinking, feeling person, impacted by a variety of factors which requires a new model: a multi-modal approach. The “biopsychosocial model” of care is defined in Relieving Pain’s glossary as:
A framework that accounts for the biological, psychological, and social dimensions of illness and disease. The biopsychosocial model provides a basis for the understanding and treatment of disease, taking into account the patient, his/her social context, and the impact of illness on that individual from a societal perspective. The model states that ill health and disease are the result of interaction among biological, psychological and social factors.
Elsewhere in the IOM report are related references to comprehensive, rehabilitative, interdisciplinary, multimodal, comprehensive-rehabilitative, individualized, patient-centered, integrated and integrative pain care models. These terms are used synonymously with biopsychosocial. In the NPS Draft Report (Box 1, pg. 8), biopsychosocial is defined much more succinctly as “a medical problem or intervention that combines biological and social elements or aspects,” and elsewhere descriptors and synonyms similar to those in the IOM report are also included.
