Pain management has traditionally focused on the physical causes and treatments of pain. However, a growing body of research indicates that psychological and social factors also play a significant role in how patients experience and cope with pain. This narrow view can lead to treatments that need to address patients’ suffering fully. There is a need to re-examine assumptions about the nature of pain and what successful management entails.
One framework that encapsulates a more comprehensive view of pain is dispositionalism. In his recent book, Dispositionalism in Musculoskeletal Care, chiropractor and lecturer Michael Vianin advocates for applying the principles of dispositionalism to transform pain management. Dispositionalism posits that a person’s traits, attitudes, beliefs, and social context shape how they respond to and interpret pain signals. It provides a model for understanding the multiple biological, psychological, and social determinants contributing to each patient’s unique pain experience.
Key Components of Dispositional Pain Care
Vianin outlines several critical components of the dispositionalist approach to pain care.
Addressing Patients’ Predictive Processing
First, it emphasizes addressing patients’ predictive processing – their expectations about pain and treatment based on past experiences. Care providers should discuss patients’ pain narratives to identify any unhelpful thought patterns that exacerbate suffering. Identifying and reshaping predictive processing can improve treatment outcomes.
Collaborating on Treatment Goals
Second, dispositionalism focuses on the clinical encounter itself as an opportunity to educate and empower patients. Practitioners must collaborate with patients to set meaningful goals and provide self-management tools. Patients become active partners in care rather than passive recipients.
Building Self-Efficacy
Third, dispositionalism attends to the self – patients’ sense of identity and self-efficacy about pain. Care plans should aim to build self-confidence and resilience. Helping patients see themselves as able to manage pain can support long-term coping skills.
Considering Social Determinants
Fourth, social determinants of health are considered, as economic stability, relationships, and environment all enable or prevent healthy behaviors. Unless social barriers are addressed, treatment gains may be temporary.
The Benefits of a Dispositional Approach
This more patient-centered care requires investment in the provider-patient relationship. As Vianin emphasizes, dispositionalism is an ongoing process, not a single treatment. By regularly re-evaluating all biopsychosocial factors influencing a patient’s distress, dispositionalism allows for genuinely individualized management plans. Research on the dispositionalist model demonstrates its benefits for both patients and providers. Patients report feeling more empowered in their care and noticing improved functioning. Meanwhile, providers describe increased satisfaction from addressing the root causes of patients’ suffering.
The Bottom Line
As the opioid epidemic has revealed the risks of reliance on medication alone for distress relief, dispositionalism offers a much-needed reckoning. distress is now understood as a complex interplay of systems in body and mind. Dispositionalism provides a framework for care that respects this complexity. Guided by its holistic view of the distress experience, we can redefine distress management to be more sustainable, humane, and effective.
Grab your copy of Dispositionalism in Musculoskeletal Care today to learn more!
