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Understanding Joint Pain Through the Biopsychosocial Model

Joint pain is one of the most common reasons people seek physiotherapy. Traditionally, pain has been explained through a biomedical model, focusing purely on physical causes such as injury or degeneration. However, growing evidence supports the biopsychosocial model, which recognises that biological, psychological, and social factors interact to influence pain.

What Is the Biopsychosocial Model?

Proposed by George Engel in 1977 [1], the biopsychosocial model suggests that our health is influenced not just by physical factors, but also by how we think, feel, and live. This approach is particularly relevant to long-term joint pain, such as in osteoarthritis or post-injury syndromes.

1. Biological Factors

These refer to physical and physiological causes of joint pain, such as:

Inflammation or joint degeneration (e.g. in osteoarthritis)
Injury (such as ligament sprains or meniscal tears)
Genetics, which can influence cartilage structure or immune response
Activity levels, either too much or too little loading of joints

For instance, elevated inflammatory biomarkers like interleukin-6 (IL-6) and cartilage degradation fragments (e.g. C1M) are associated with joint pain severity in knee osteoarthritis [2].

2. Psychological Factors

Pain is not just physical—it’s also shaped by how we perceive it. Common psychological influences on joint pain include:

Stress and anxiety, which can amplify pain signals
Depression, which reduces pain tolerance and impairs motivation
Pain catastrophising, fearing the worst about your pain
Self-efficacy, belief in your ability to manage pain and recover

Patients with higher self-efficacy often report lower pain intensity and better physical function [3]. Conversely, stress may lead to stress-induced hyperalgesia, where the nervous system becomes more sensitive to pain [4].

3. Social Factors

Social context can significantly affect how we experience and respond to joint pain:

Support from family and friends can reduce the emotional burden
Workplace stress or job demands can worsen pain through repetitive strain or low morale
Cultural beliefs influence how people interpret and respond to symptoms

In a study of patients with osteoarthritis, reduced social participation was associated with increased pain and poorer mental health [5].

Why Is This Important for You?

Understanding pain from a biopsychosocial perspective can help you:

See that pain does not always mean harm
Recognise the role of stress, mood, and lifestyle in your symptoms
Feel more in control of your recovery by targeting multiple aspects of your wellbeing

This approach encourages active coping, such as exercise, pacing, mindfulness, and social support—all of which are shown to improve outcomes.

Visual Overview

Here is a visual summary of the biopsychosocial model of joint pain:

Source: Chrystie Tyler, Washington University School of Medicine [6]

Conclusion

Joint pain is not solely a physical ailment but a complex experience shaped by biological, psychological, and social factors. By adopting the biopsychosocial model, physiotherapy can provide a more comprehensive and effective approach to pain management, leading to better outcomes.

References

Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36.
Bay-Jensen AC, Liu Q, Byrjalsen I, Li Y, Wang J, Pedersen C, et al. Enzyme-linked immunosorbent assay (ELISA) protocols for measuring serum and synovial levels of C1M and IL-6 in patients with knee osteoarthritis. Osteoarthritis Cartilage. 2019;27(2):248–54.
Somers TJ, Wren AA, Shelby RA, Keefe FJ. Understanding pain and disability in osteoarthritis: the role of catastrophizing, kinesiophobia, and self-efficacy. Arthritis Care Res. 2012;64(10):1539–45.
Jennings EM, Okine BN, Roche M, Finn DP. Stress-induced hyperalgesia. Prog Neurobiol. 2014;121:1–18.
van der Esch M, Knoop J, van der Leeden M, Dekker J, van der Meulen WJ, Lems WF, et al. Self-reported fatigue in patients with knee or hip osteoarthritis: its relationship with physical function and psychosocial factors. Arthritis Care Res. 2011;63(4):494–500.
Tyler C. Biopsychosocial (BPS) model [Internet]. Washington University School of Medicine; [cited 2025 May 18]. Available from: https://publichealth.wustl.edu/biopsychosocial-model

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