Psychosocial factors in osteopathic practice: To what extent should they be assessed?

Abstract

Psychosocial factors have been hypothesised to contribute causally to both acute and chronic musculoskeletal pain, and are also considered to be obstacles to recovery. The assessment of a patient with a pain complaint comprises a standard osteopathic interview and physical examination. During the consultation the osteopath may explore psychosocial aspects of the patients life based on the concept that psychosocial factors may have been related to the onset of pain, the transition from acute to chronic pain, or may be acting as factors which maintain pain and prevent a return to normal function. The main aim of this commentary is to develop a pragmatic answer to the question “to what extent should psychosocial factors be explored in those patients who present to osteopaths with a pain complaint?” In order to seek an answer to this question a search for relevant articles was conducted using the National Library of Medicine Pub Med Clinical Queries search function, and the Cochrane Database of Systematic Reviews. The most recent systematic reviews on psychosocial risk factors for pain are summarised. Also, the most recent systematic reviews regarding the management of psychosocial factors in patients with pain are summarised. It is reported that while there is evidence that psychosocial issues are an important aspect of the pain experience, there is insufficient evidence from which to make firm conclusions about (1) which instruments should be used to measure psychosocial variables, and (2) which combination of psychosocial factors constitutes risk for specific pain syndromes. It is also reported that management strategies such as cognitive-behavioural therapy and biopsychosocial multidisciplinary treatment are effective at improving outcomes in certain populations; however, these approaches are no more efficacious than other approaches, such as exercise therapy. These findings suggest that osteopaths should purposely evaluate psychosocial factors in patients who present with pain, and should address relevant issues as part of their osteopathic management of the patient. However, it is proposed that the formal measurement of psychosocial factors using questionnaires is unnecessary in many patients. Also, specific psychological management or multidisciplinary treatment is not required in order to achieve meaningful outcomes for most patients.