Therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to
applying effective treatment
It is well established that the biomedical model falls short in explaining chronic musculoskeletal pain.
Although many musculoskeletal therapists have moved on in their thinking and apply a broad biopsychosocial
view with regard to chronic pain disorders, the majority of clinicians have received a biomedical-focused
training/education. Such a biomedical training is likely to influence the therapists’ attitudes and core
beliefs towards chronic musculoskeletal pain. On the other hand, many musculoskeletal therapists have moved
on in their thinking and apply a broad biopsychosocial view with regard to chronic pain disorders.
Likewise, an increasing number of musculoskeletal physiotherapy / manual therapy curricula emphasize the
biopsychosocial model, and teach behavioral treatments in addition to hands-on treatment.
Therapists should be aware of the impact of their own attitudes and beliefs on the patient’s attitudes and beliefs.
In case the therapist holds strong biomedical beliefs regarding chronic musculoskeletal pain
(e.g. chronic low back pain is solely due to instability of the lumbar spine, improper lifting of
heavy objects or poor posture; manual therapy for chronic whiplash associated disorders patients
should comprise of hands-on muscle and cervical joint treatment solely), the patient will adopt these beliefs accordingly.
As patient’s attitudes and beliefs influence treatment adherence, musculoskeletal therapists should be aware
that focusing on the biomedical model for chronic musculoskeletal pain is likely to result in poor
compliance with evidence based treatment guidelines, less treatment adherence and a poorer treatment outcome.
Here, we provide clinicians with a 5-step approach towards effective and evidence-based care for patients with
chronic musculoskeletal pain. The starting point entails self-reflection: musculoskeletal therapists can easily
self-assess their attitudes and beliefs regarding chronic musculoskeletal pain.
Once the therapist holds evidence-based attitudes and beliefs regarding chronic musculoskeletal pain,
assessing patients’ attitudes and beliefs will be the natural next step.
Such information can be integrated in the clinical reasoning process, which in turn results in individually-tailored
treatment programs that specifically address the patients’ attitudes and beliefs in order to improve treatment
adherence and outcome.