The Biopsychosocial Model Of Pain ....

...In Relation To Exercise And Training.

When we think of pain, particularly concerning exercise and training, we tend to think of physical injury and rehabilitation- biology.

Often, we neglect the flip side of the coin- the psychological and social influences of pain.


The biopsychosocial model of pain builds upon the biomedical model of pain- a more ‘traditional’ model that considers biological factors such as hormones, genetics, and endogenous opioids as the sole identifier of pain.

This older model categorizes pain more simply as a neurological and sensory (biological) experience.

However, In 1977, along came George Engel to switch things up!

Understanding that this model was somewhat limited, he proposed a more in-depth approach to understanding pain and created a model that revolutionized how we understand medicine today.[1]

This new approach incorporates psychological factors such as mentality, mood, and coping, and social factors such as socioeconomic status, gender, ethnic background, and age, with biological factors.

The result? A more informed, well-rounded understanding and approach to treating pain.

According to Practical Pain Management, the biopsychosocial model has led to the most therapeutic and cost-effective pain management programs for the treatment of chronic pain.

And considering pain currently affects approximately 50 million people in the US alone[2], this is good news!


When it comes to competing as an athlete, the physical demands of training often lead to pain and injury.

Injury is an extremely individual physical, immunological, cognitive, social, and emotional experience of pain.[3]

Treating an athlete and exercise-related injury means understanding specifically how pain will affect someone- physically, socially, and mentally, and how this will impact their recovery.

Strategies can subsequently be put in place to help negate any influencing factors and improve recovery and function.

While the primary method of treating pain typically involves injury diagnosis and physical treatment, adopting a strategy for emotional and social considerations might be more complex (but necessary.)



Research indicates that stress (in any form) can impact homeostasis (balance) within the body, contributing to ill health.[5]

According to the Biopsychosocial Model of Stress and Athletic Injury and Health (BMSAIH), psychophysiological factors such as negative life-event stress, alongside behavioral mechanisms such as poor sleep[6] and impaired self-care, can lead to prolonged recovery and increased risk of injury.[7]

Stress, anxiety, and fear related to someone’s lifestyle or psychological state can also impact their experience of pain (post-rehab) when a physical problem is no longer present.

On the flipside, pain itself can negatively affect mindset, mentality, confidence, and ability to sleep.


The experience of pain can differ depending on an athlete’s age, socioeconomic status, ethnic background, and gender.[8]

These, in themselves, can create barriers for athletes in terms of injury diagnosis and pain management.

For example:

· Does the athlete have the means to access care?

· Does the athlete’s age make them more or less likely to suffer?

· Do they have a support system?

· Are they unemployed or over-worked?

· Do they have access to sufficient nutrition?

· What is their personal/family situation- do they have any dependants or personal stress?

These questions are the tip of the iceberg in terms of understanding the experience of pain and injury in athletes, the inability to treat existing pain, and the likelihood of injury.


No person is the same; treatment and management of pain within exercise and training is a complex issue.

By considering individual and personal factors such as background, lifestyle, and emotional state, we can begin to understand the impact it might have on a person’s experience, treatment, and management of pain.

Happy training gymers x


[1] SMITH RC. The Biopsychosocial Revolution: Interviewing and Provider-patient Relationships Becoming Key Issues for Primary Care. J Gen Intern Med. 2002;17(4):309-310. doi:10.1046/j.1525-1497.2002.20210.x [2] Cited 04.07.21, CDC,,prevalence%20associated%20with%20advancing%20age. [3] Cited 05.07.21, BJSM, [4] Cited 05.07.21, [5] Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057-1072. Published 2017 Jul 21. doi:10.17179/excli2017-480 [6] Cited 05.07.21, [7]Cited 06.07.21, [8] Darnall BD, Carr DB, Schatman ME. Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. Pain Med. 2017;18(8):1413-1415. doi:10.1093/pm/pnw166

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