Weiner Bradley K
Weill Cornell Medical College, Department of Orthopaedics, The Methodist Hospital, Houston, TX, USA.
Spine (Phila Pa 1976). 2008 Jan 15;33(2):219-23. doi: 10.1097/BRS.0b013e3181604572.
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.
生物心理社会模型的脊柱研究进展。
回顾并讨论该模型在脊柱护理应用中的优缺点。
疾病的生物心理社会模型已经（并将继续）对脊柱护理产生重大影响。它以积极的方式改变了我们看待脊柱疾病、治疗患者以及评估结果的方式。然而，迄今为止，关于其实施方面的问题却很少被讨论。
通过查阅涵盖生物心理社会模型一般理论的文献以及该模型应用于脊柱护理的文献，进行综述，评估该理论在我们领域应用的优缺点。
正如生物医学模型通过对病理解剖疾病的客观研究实现了（并持续实现着）重大医学进展一样；生物心理社会模型通过将疾病放回患者身上，并强调在患者独特的生物、心理、社会和经济环境中所经历的疾病，也带来了类似的进展。因此，该模型的优势在于它清楚地提醒我们，对于生活在困难社会条件下的持续性下腰痛患者，临床决策比那些没有这种情况的患者更为复杂。然而，对该模型的担忧也是切实存在的，包括将其作为评估结果的主要模式而忽视其他潜在因素；在基础病理未明确界定的情况下，医学/历史上倾向于高估心理社会因素；该模型所基于的理论是否可证伪/科学；它是否具有解释力或预测力；其实施是否能改善结果；以及它是否导致背痛患者的“医学化”。
生物心理社会模型已很容易地应用于脊柱护理的各个方面，具有许多积极意义。然而，也存在一些担忧和负面影响，认识到这些应该能让我们更好地理解该模型在何时何地能得到最有效的应用。
