The Socio-Psycho-Biological Model: The Need to Flip the System

The Socio-Psycho-Biological Model: The need to flip the system

Learning Objectives

As a result of participating in this activity, learners will be able/better able to:

• Apply new strategies to increase or enhance rapport with patients
• Utilize responses from patients about isolation, loneliness, abandonment, stigmatization, marginalization, trauma, or abuse to improve treatment plans
• Assess signs of chronicity 

Outline

The mechanisms and mediators of pain at the cellular level have evolved as social mediators.

Clinicians spend a great deal of time focused upon pain at a patient-by-patient level. Yet pain is experienced as, and acts upon, a group of interrelated systems from levels of the individual to the society as a whole. Group processes (e.g., family, job, culture, religion) mold the experience and response to therapy of acute, chronic, and cancer-related pain.

Chronic pain has a corrosive effect upon family, social and vocational functions. It furthers isolation, which in turn exacerbates pain and suffering. Failure to address the social dimensions of pain can render rehabilitative efforts futile.

Pulling from a lifetime of research and clinical practice, Dr. Carr’s Legacy Lecture charts a path through:

• The biological utility of the opioid system
• What medicine can learn from other scientific disciplines
• Systems, structures, and interactions within the provision and utilization of health care

Learn to better-establish rapport with patients, uncover root causes and patient motivations that will increase adherence to treatment plans, and address suffering in addition to the anatomical sources of pain.

This lecture is a blend of neuroscience, social psychology, economics, cognitive psychology, genetics, heredity, and developmental biology. 

Desirable Physician Attributes

• Systems-based Practice [ACGME/ABMS] Awareness and responsiveness to larger context and system of health care, use of system resources
  
• Patient Care [ACGME/ABMS & IOM] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
• Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
• Interpersonal and Communication Skills [ACGME/ABMS] The effective information exchange and teaming with patients, their families, and other health professionals
• Professionalism [ACGME/ABMS] Carrying out professional responsibilities, ethics, sensitivity

This course addresses requirements for physicians and surgeons to participate in continuing education that includes specified instruction in the understanding of implicit bias in medical treatment.

1. Cultural competency. For the purposes of this section, “cultural competency” means a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. At a minimum, cultural competency is recommended to include the following:
   1. Applying linguistic skills to communicate effectively with the target population.
   2. Utilizing cultural information to establish therapeutic relationships.
   3. Eliciting and incorporating pertinent cultural data in diagnosis and treatment.
   4. Understanding and applying cultural and ethnic data to the process of clinical care, including, as appropriate, information pertinent to the appropriate treatment of, and provision of care to, the lesbian, gay, bisexual, transgender, and intersex communities.
      

Accreditation & Designation

Release date: This activity was released 8/28/2021.

Termination date: The content of this activity remains eligible for CME Credit until 8/27/2024, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships

Neither the presenter, reviewers nor any other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, any financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Additional Reading

• George, E., & Engel, L. (1980). The clinical application of the biopsychosocial model. American journal of Psychiatry, 137(5), 535-544.
• Fillingim, R. B., Loeser, J. D., Baron, R., & Edwards, R. R. (2016). Assessment of chronic pain: domains, methods, and mechanisms. The Journal of Pain, 17(9), T10-T20.
• Pizzo, P. (2011). Relieving pain in America: a blueprint for transforming prevention, care, education, and research.
• Borrell-Carrió, F., Suchman, A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. The Annals of Family Medicine, 2(6), 576-582.
• Carr, D. B., & Cousins, M. J. (2014). The Anesthesiologist and Pain: A Historical Memoir. In The Wondrous Story of Anesthesia (pp. 811-827). Springer, New York, NY.
• Wager, T. D., Atlas, L. Y., Lindquist, M. A., Roy, M., Woo, C. W., & Kross, E. (2013). An fMRI-based neurologic signature of physical pain. New England Journal of Medicine, 368(15), 1388-1397.
• Walters, E. T. (1992). Possible clues about the evolution of hyperalgesia from mechanisms of nociceptive sensitization in Aplysia. Hyperalgesia and Allodynia, 45-58.
• Decety, J., & Keenan, J. P. (2006). Social neuroscience: A new journal. Social Neuroscience,, 1(1), 1-4.
• Carr, D. B. (2009). What does pain hurt?. Pain Clin Updates, 17, 1-6.
• Darwin C:: The Descent of Man, and Selection in Relation to Sex. Selections and commentary by Carl Zimmer. New York, Plume, 2007, pp 157 pp
• Sidharth, B. G. (2008, May). The thermodynamic universe. In AIP Conference Proceedings (Vol. 1018, No. 1, pp. 7-14). American Institute of Physics.