pain can be influenced by more than just your muscles and joints

By Duke Autret, Myotherapist
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It’s important to recognise and understand that musculoskeletal health and pain is highly influenced by the overall health, function and condition of the body and its context or environment it lives within.
The Biopsychosocial (BPS) Model is a holistic and interdisciplinary approach to understanding health and illness that considers the biological, psychological, and social factors that influence our well-being. One key component of the BPS Model is the concept of "predisposing and perpetuating factors" that can lead to the development of conditions or worsen existing ones, making it harder to recover. In this article, we will explore the most common perpetuating factors and their relation to the BPS Model.

These determinant factors of pain can be classified into different categories such as metabolic, social, and physical factors. Let's take a closer look at these factors:


Metabolic Factors 

Hormonal imbalances, poor nutrition, and chronic diseases can contribute to the onset and perpetuation of pain.

• Sleep: Insomnia, lack of sleep, or poor sleep quality can have a significant impact on our physical and mental health. Sleep is essential for our bodies to repair, recover and regenerate, and inadequate sleep has been linked to a wide range of health problems, including obesity, diabetes, heart disease, and depression. The importance of sleep in maintaining good health and encouraging patients to address sleep problems is part of a comprehensive treatment plan.

 

• Inflammation: Although a natural response of the body to injuries or infections, persistent or chronic inflammation can contribute to a range of health problems, including autoimmune disorders, cardiovascular disease, and cancer, as well as maintaining irritation of joint structures, muscles, and nerves. Persistent Inflammatory processes can be the result of all metabolic, psychosocial, and physical factors. The BPS Model acknowledges the role of longstanding inflammation in the development and progression of many chronic conditions and encourages finding ways to reduce inflammation through lifestyle changes such as, in particular, diet and exercise.

 

• Nutrition: The food we eat plays a vital role in our overall health and well-being. A poor diet can lead to a range of health problems, including obesity, diabetes, and heart disease. The rise of the modern diet where a bulk of staple and accessible consumption is ultra processed foods and includes high amounts of sugars and carbs has been linked to an over 60% increase in all cause mortality! And of course, being so fundamental to overall metabolic health, clean food and good nutrition is as much a part of addressing musculoskeletal pain as it is warding away disease. 

 

• Toxicity/Pollution: Exposure to toxins and pollution can contribute to a range of health problems, including respiratory issues, cancer, neurological problems and beyond. There are many historic and current examples, one recent example of such an environmental health risk factor is the discovery of Phthalates or micro-plastics which now contaminate much of the fast foods industry. The BPS Model acknowledges the importance of reducing exposure to toxins and pollutants as part of a comprehensive treatment plan.

Psychological Factors

The breadth of psychological, cognitive and emotional health factors are beyond the scope of this article however here are some examples as food for thought.
 

• Emotions: such as Joy, Love, and Care can be powerful antidotes which help counteract stress, anxiety, grief, depression, and other states and emotions that can overwhelm us. Emotions are a major influence on how, how much and whether you experience pain at all even if there is underlying tissue pathology or systemic disease. Traumatic events in our past, whether they be major and acute, or more subtle but repeated and cumulative, will have an effect on the personality, disposition, response and relationship we have with pain in our body.  Focusing on the use and awareness of emotion is a crucial part of repair and healing at the level of the physical body including inflammatory processes and pain perception/generation.

 

• Purpose: having a sense of purpose and meaning in life can improve overall well-being. This can come from a variety of sources, including spirituality or religion, parenting, serving/volunteering, personal growth/development and challenges. A meaning crisis can be an overlooked part of physical health but is critical for emotional/mental health and thus in turn indispensable for pain management and  physical health.

 

• Balance Material Wealth: While financial security is important, an excessive focus on material wealth can lead to dissatisfaction, addiction, negative emotions, and all the implications thereof. Likewise an instability of financial resources is obviously linked to health risk factors. This interesting study speaks to the relationship between wealth, health and happiness/satisfaction in life.

 

• Balance of Stress: Some stress can be beneficial for health, it's what helps us build capacity and resilience (a process called Hormesis), but too much stress can be harmful. Finding a balance of stress that promotes growth and resilience without overwhelming the individual is key. Physical Exercise, Cold water immersion, and Saunas are all common ways in which people engage in building up their natural immunity to stress. There is much research on the value and effects of all such activities, here is one from 2018 on hot and cold bathing.

 

• Nature and Beauty: Last but definitely not least, exposure to nature and beauty can improve emotional and physical health massively. This can come from spending time in natural settings, such as parks or forests, or from experiencing art and other forms of beauty. Once again the research on this is copious. One final link for those who are of nerd level interest is some hard science on the importance of ‘natural’ rhythms suited for our particular flavour of evolutionary biology. 

Social Factors

Our social connections and relationships play a most significant role in our overall health and well-being. A lack of social support or unhealthy relationships can contribute to the perpetuation of pain. Our social connections and the quality of our relationships have a significant impact on our mental and physical health. A lack of social support or unhealthy relationships have also been linked to a range of health problems, including depression, anxiety, forms of dementia, and heart disease.
The social factors of health cannot be underestimated, in fact a whole host of studies have linked social isolation to being the biggest health risk today, especially for middle-aged men!
In the BPS Model we recognise the importance of strengthening social support networks as part of a comprehensive treatment plan. 


Physical Factors

Physical factors such as inactivity/sedentism, load, and motor control can contribute to the perpetuation of pain. The BPS Model acknowledges the importance of addressing these factors by exploring ways to increase physical activity levels, optimising load levels, and assessing and addressing motor control issues through refining movement patterns, alignment, and body awareness.

• Physical Inactivity & Sedentism: Physical activity is essential for maintaining good health, but many of us lead sedentary jobs and lifestyles that contribute to a range of health problems, including obesity, diabetes, heart disease, depression, anxiety, and loss of musculoskeletal conditioning. These guidelines show the recommended levels of physical activity that have been set out by the World Health Organisation so as to give people a good indicator of where they sit on this scale and be encouraged toward more optimal physical activity levels as part of maintaining good biological (metabolic and mechanical) and psychological (cognitive and emotional) health.

 

• Load Management: Load refers to the amount of stress placed on the body, whether from physical activity, work, or other factors. Too much load in either frequency (overuse) or intensity (overload) can lead to injury or exacerbate existing conditions, while too little load can contribute to deconditioning and weakness. Wherever one sits on this spectrum will be an important factor to identify so as to avoid overuse injuries and promote good progressive strength and endurance building. The importance of load management in maintaining good health and encouraging exploration of ways to optimise load levels whether in work, sports, or activities of daily living is part of a comprehensive treatment plan.

 

• Motor Control: Refers to the way in which the body moves and functions. Poor motor control can contribute to a range of health problems, including chronic pain, injury, and decreased mobility as it relates to increased loading of joints, muscles, and connective tissues where movement patterns are suboptimal. We speak of concepts and attributes such as (core) stability, alignment, proprioception, interoception, kinesthetic awareness, strength, endurance, and mobility.

By understanding the perpetuating factors of pain and their relation to the BPS Model, you can take steps to improve your overall health and well-being. Remember, pain is not just a physical symptom but can also be influenced by psychological and social factors. By addressing all aspects of your well-being, you can achieve long-term pain relief and optimal health.

If you are experiencing pain, it is essential to seek help from healthcare practitioners who take a holistic approach to your well-being. By considering the biological, psychological, and social factors that contribute to your pain, a comprehensive treatment plan can be developed that addresses the perpetuating factors and promotes your overall health and well-being. Our friendly staff here at Simple Wellness are all trained and well versed in this approach and are here to help you with your health needs.