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A Specialist Practice: Biopsychosocial Musculoskeletal Medicine

Pain is the most common symptom that drives people into healthcare, and all the clinical guidelines for understanding and treating pain state pain must be considered from a Biopsychosocial perspective. Put simply, the Biopsychosocial model understands that the question of "What's going on in your life?" is just as, if not more important than, the question of "What have you done?" Whilst many practitioners believe there is a simple biomechanical explanation (often linked to their particular practice) for back or neck pain, the science is clear that musculoskeletal pain is a consequence of a complex interaction of many factors. Take posture, for instance. We often hear patients say they have been told poor posture has caused their problems, but why now rather than a week, a month, or a year ago?

The Biopsychosocial model informs all aspects of physical and mental health, with recent research suggesting a much stronger link between body and mind than previously thought. Consultations must consider the patient's symptoms, the context in which they occur, and their reaction to them (which may be unconscious), integrating body and mind in order to reach a realistic (and patient-centred) outcome.

Musculoskeletal pain rarely occurs in isolation from other symptoms and must be considered in the wider context of the patient's health and wellbeing. Does the pain disturb your sleep, or is the pain and sleep disturbance a manifestation of the "What's going on?" question?

Back and neck pain (including headaches and pregnancy-related pain) are common problems we see together with many other 'medically unexplained symptoms' otherwise known as 'functional somatic pain syndromes'. These include but are not limited to acute, chronic or widespread bodily pain, fibromyalgia, chronic fatigue syndrome, temporo-mandibular joint problems, non-specific chest and pelvic pain, in addition to other symptom pictures that cannot be readily explained by a single diagnosis or cause, and all form part of our practice.

What to expect when you visit Specialist Osteopaths:

As we are a boutique practice you will speak directly with either Nick or Shelley at all times and we will endeavour to make you an appointment with your practitioner of choice at a time that suits you best. Please note however that Shelley's times will be limited by her maternity leave.

Your osteopath will first take a detailed case history. There is now broad agreement that human illness and disability can only be understood and managed according to a biopsychosocial model which includes biological, psychological and social dimensions, and the case history will reflect this. There are many factors that can influence our symptoms and they all need to be considered.

Your story is the most important part of the consultation with any physical examination, diagnostic tests and imaging reports (eg. x-rays, CT scans) then being taken into consideration. Once this is completed any treatment required will be discussed with you in order to help you give your informed consent to treatment. Advice and reassurance will also be offered about your problem, again this advice will be based on the best available information and scientific evidence.

As the famous physician Sir William Osler said over one hundred years ago:
"If you talk to a patient long enough, they will tell you what's wrong with them"
and this still holds true today.

There is no evidence that long term treatment is beneficial so you will not be expected to sign up for long courses of treatment, the key is to get the pain relieved as quickly as possible so that you can stay in control of your life, and not let it be ruled by your symptoms.

Consultations normally take around 30-40 minutes but may run longer depending on the nature of the problem.


It is important to understand acute and chronic pain and to have, and follow, an evidence-based plan. This Australian video details this in less than 5 minutes. After your initial consultation with one of our specialist osteopaths at Integrative Pain Care we will discuss your individual pain plan with you, and provide it in writing as required. For further informative videos please see the Specialist Osteopaths Facebook page and don't forget to 'like us'