Evaluating the biopsychosocial milieu of chronic pain

The biopsychosocial model was developed in the 1970s in psychiatry and spread to other fields, gaining special prominence in chronic pain assessments. Currently, most treatment guidelines for chronic pain recommend psychosocial assessments for all patients and multidisciplinary biopsychosocial assessments for patients who fail to respond to routine treatment or patients with complicating psychopathology, including substance usage. There is strong evidence for the association between chronic pain and psychosocial factors and for the efficacy of psychosocial treatments in chronic pain. However, there is limited existing evidence showing the benefits of performing a multidisciplinary biopsychosocial assessment largely due to limited randomized controlled trials. This chapter explores the history of the biopsychosocial model, evidence in support of its usage, and provides tips on performing this assessment. We include a section on special concerns for patients with substance use disorders.