The Biopsychosocial model was first conceptualised by George

Engel in 1977, suggesting that to understand a person's medical

condition it is not simply the biological factors to consider, but
also the psychological and social factors.
 Bio (physiological pathology)
 Psycho (thoughts emotions and behaviours such as
psychological distress, fear/avoidance beliefs, current
coping methods and attribution)
 Social (socio-economical, socio-environmental, and
cultural factors suchs as work issues, family circumstances
and benefits/economics)
This model is commonly used in chronic pain, with the view that
the pain is a psychophysiological behaviour pattern that cannot
be categorised into biological, psychological, or social factors
alone. There are suggestions that physiotherapy should integrate
psychological treatment to address all components comprising
the experience of chronic pain. 

Physiotherapists must know how biopsychosocial factors

interact in patients with chronic pain to explain the perpetuation
of this condition and use it as a basis for planning the
intervention program. The evidence has suggested a clinical
biopsychosocial assessment for the physiotherapeutic
management of patients with chronic pain in order to understand
and explain the predominant mechanism of pain and
psychosocial factors that may or may not be modified for the
patient to improve their condition.
This clinical evaluation is carried out during the data collection
at the patient's entrance. A practical guide is proposed to take
biopsychosocial data using the PSCEBSM (Pain–Somatic and
medical factors–Cognitive factors–Emotional factors–
Behavioral factors–Social factors–Motivation) model.
P- Type of pain
Clinical identification and differentiation of the dominant pain
mechanism: nociceptive pain, neuropathic pain or non-
neuropathic pain of central sensitization. Using the following
tools:
1. Classification criteria for differentiating predominant pain
proposed by Nijs et al.
2. Widespread pain index/Body Diagram : ≥ 7 score
suggesting generalized pain, therefore, non-neuropathic
pain of central sensitization
3. Central Sensitization Inventory (CSI) : 40 score suggesting
non-neuropathic pain of central sensitization
S- Somatic and medical factors
For physical therapist the physical examination is a very
important part of his intervention, therefore it is essential to be
aware that some findings of clinical examinations such as
mobility, strength, neurodynamics, coordination, etc. could be
altered because there is greater sensitivity to mechanical
stimulation and modified movement patterns in patients with
non-neuropathic pain of central sensitization. The main goal in
this stage is to evaluate the quality of movement, if the pattern
of movement causes the pain to persist and if there is
kinesiofobia
Ask about current or previous health conditions, the disuse of
body parts, changes in movement patterns, exercise capacity,
strength and muscle tone during movement, the action of the
drug in the CNS It is useful for data collection
C- Cognition / Perceptions
Both influence biologically on hypersensitivity in the brain by
activating neuromatrix pain and also influence the emotional and
behavioral factors. :
1. Ask about perceptions: expectations of the intervention,
expectations of the prognosis of their pain, understanding
of their situation and the strategies they have available to
face their situation, what the pain represents emotionally
2. Brief Illness Perception Questionnaire (Brief IPQ)
3. Pain Catastrophizing Scale (PCS)
E- Emotional factors
Ask if there is fear of specific movements, avoidance behaviors,
psychological traumatic appearance of pain, psychological
problems at work, family, finances, society, etc. It is also
suggested to use the following scales:
1. State-Trait Anxiety Inventory (STAI)
2. Tampa-Scale of Kinesiophobia (TSK)
3. Injustice Experience Questionnaire (IEQ)
 4. Patient Health Questionnaire-2 (PHQ-2), or Patient Health
Questionnaire-9 (PHQ-9), or Center of Epidemiologic
Studies Depression Scale (CES-D)
B- Behavioral factors
Can lead to avoid activity or movement due to fear, which in
turn is presented as physical inactivity or disuse and, finally,
disability. Therefore it is important to evaluate the behavior and
adaptations that the patient has made due to the pain.
S- Social factors
It refers to the social and environmental factors in which the
patient develops, which could be useful and supportive or
harmful and stressful for the improvement of the patient's health
condition. The data collection can be divided as follows:
1. Housing or living situation
2. Social environment
3. Work
4. Relationship with the partner
5. Previous interventions
M- Motivation
Evaluating the motivation in the patient and his willingness to
change is useful to modify his thoughts regarding the
relationship pain-kinesiophobia, pain-disability, and acceptance-
catastrophism. For this purpose, the following scale can be used
1. Psychology Inflexibility in Pain Scale (PIPS)
Clinical Contribution
The use of the biopsychosocial model as a clinical practice guide
in physiotherapy allows the physiotherapist to be aware of all
the factors that influence the patient's state of health. In addition,
it allows laying the foundations of pain neuroscience education
However, the psychosocial factors with which the patient deals
can mean the intervention of other health professionals besides
the physiotherapist. Therefore, it is important to take into
account the professional limits, as well as the ethical principles
that ensure the comprehensive management of the patient.
The following videos emphasize the importance of using the
biopsychosocial model to improve patient functionality and the
problem that currently exists for physiotherapists in the use of
this approach.