Indian Journal of Palliative Care
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Table of Contents 
Year : 2013  |  Volume : 19  |  Issue : 2  |  Page : 126-127

Evidence-based practice in chronic pain: A multidimensional biopsychosocial paradigm is the "need of the hour" in palliative care

1 Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
2 Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India

Date of Web Publication21-Aug-2013

Correspondence Address:
Senthil Paramasivam Kumar
Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1075.116705

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How to cite this article:
Kumar SP, Kumar A. Evidence-based practice in chronic pain: A multidimensional biopsychosocial paradigm is the "need of the hour" in palliative care. Indian J Palliat Care 2013;19:126-7

How to cite this URL:
Kumar SP, Kumar A. Evidence-based practice in chronic pain: A multidimensional biopsychosocial paradigm is the "need of the hour" in palliative care. Indian J Palliat Care [serial online] 2013 [cited 2020 Aug 12];19:126-7. Available from:


I read with interest and enthusiasm the article on evidence-based practice of chronic pain and I wish to congratulate Garg et al. [1] on their breakthrough initiative to enlighten the clinical and scientific palliative care settings with the re-emerging evidence-based practice paradigm, which is the need for the hour in developing countries.

I wish to add a few points on the article;

The paper was titled so, but I could find little or no information on non-pharmacological interventions for management of chronic pain in terms of established high-level evidence. Recently, published systematic reviews and meta-analyses unanimously recommend physical activity for prevention and/or management of both cancer [2] and non-cancer chronic pain for patients of all ages around the globe. [3]

Physical therapy treatment options for chronic pain included the use of physical modalities, transcutaneous electrical nerve stimulation, manual physical therapy and exercise therapy, which not only enable symptom control, but also enhance quality-of-life. [4] The updated evidence of efficacy currently exists for virtual reality, [5] graded motor imagery [6] and activity pacing prescriptions. [7],[8]

Recent understanding of chronic pain had shifted from a biomedical dimension to a behavioral dimension [9] leading to a biopsychosocial approach [10] to evaluation and management of chronic pain.

Interdisciplinary programs involve the use of multiple disciplines such as physical and occupational therapy, pain psychology, medical pain management, vocational rehabilitation, relaxation training and nursing educations. [11] Such an interdisciplinary rehabilitation approach was shown to be effective in management of people with chronic pain. [12]

Physical activity as a part of an individualized exercise prescription provides a safe, cost-free, non-pharmacologic way of managing pain has been found to reduce anxiety and depression, improve physical capacity, increase functioning and independence and reduce morbidity and mortality. [13] Such a prescription when combined with the cognitive-behavioral therapy as a multi-component approach had garnered good evidence of effectiveness as stand-alone, adjunctive treatments for patients with chronic pain. [14]

The biopsychosocial disease consequence model describes the rehabilitation process of patients with chronic pain as a three-axial (biopsychosocial) and 3D (disease consequences) assessment and intervention grid for functioning, [15] which is yet to be explored in evidence-based practice for chronic pain.

  References Top

1.Garg R, Joshi S, Mishra S, Bhatnagar S. Evidence based practice of chronic pain. Indian J Palliat Care 2012;18:155-61.  Back to cited text no. 1
  Medknow Journal  
2.Albrecht TA, Taylor AG. Physical activity in patients with advanced-stage cancer: A systematic review of the literature. Clin J Oncol Nurs 2012;16:293-300.  Back to cited text no. 2
3.Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka S, et al. Evidence-based intervention in physical activity: Lessons from around the world. Lancet 2012;380:272-81.  Back to cited text no. 3
4.Kumar SP, Jim A. Physical therapy in palliative care: From symptom control to quality of life: A critical review. Indian J Palliat Care 2010;16:138-46.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Shahrbanian S, Ma X, Korner-Bitensky N, Simmonds MJ. Scientific evidence for the effectiveness of virtual reality for pain reduction in adults with acute or chronic pain. Stud Health Technol Inform 2009;144:40-3.  Back to cited text no. 5
6.Bowering KJ, O'Connell NE, Tabor A, Catley MJ, Leake HB, Moseley GL, et al. The effects of graded motor imagery and its components on chronic pain: A systematic review and meta-analysis. J Pain 2013;14:3-13.  Back to cited text no. 6
7.Andrews NE, Strong J, Meredith PJ. Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: A systematic review and meta-analysis. Arch Phys Med Rehabil 2012;93:2109-2121.e7.  Back to cited text no. 7
8.Robinson K, Kennedy N, Harmon D. Review of occupational therapy for people with chronic pain. Aust Occup Ther J 2011;58:74-81.  Back to cited text no. 8
9.Prem V, Karvannan H, Chakravarthy R, Binukumar B, Jaykumar S, Kumar SP. Attitudes and beliefs about chronic pain among nurses-biomedical or behavioral? A cross-sectional survey. Indian J Palliat Care 2011;17:227-34.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.Nielson WR, Weir R. Biopsychosocial approaches to the treatment of chronic pain. Clin J Pain 2001;17:S114-27.  Back to cited text no. 10
11.Stanos S. Focused review of interdisciplinary pain rehabilitation programs for chronic pain management. Curr Pain Headache Rep 2012;16:147-52.  Back to cited text no. 11
12.Pietilä Holmner E, Fahlström M, Nordström A. The effects of interdisciplinary team assessment and a rehabilitation program for patients with chronic pain. Am J Phys Med Rehabil 2013;92:77-83.  Back to cited text no. 12
13.Sullivan AB, Scheman J, Venesy D, Davin S. The role of exercise and types of exercise in the rehabilitation of chronic pain: Specific or nonspecific benefits. Curr Pain Headache Rep 2012;16:153-61.  Back to cited text no. 13
14.Hassett AL, Williams DA. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol 2011;25:299-30.  Back to cited text no. 14
15.Talo S, Rytökoski U, Hämäläinen A, Kallio V. The biopsychosocial disease consequence model in rehabilitation: Model development in the Finnish 'work hardening' programme for chronic pain. Int J Rehabil Res 1996;19:93-109.  Back to cited text no. 15


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