Chronic pain affects over 50 million adults in the United States, making it one of the most
prevalent public health issues today. For decades, the medical field has struggled to effectively
treat chronic pain conditions. However, an emerging philosophy called “dispositionalism” is
providing new insights and shaping the future of pain care.
Understanding Dispositionalism
Dispositionalism is a concept comprehensively discussed by physical therapist and researcher
Dr. Michael Vianin in his acclaimed book “Dispositionalism in Musculoskeletal Care.” It
emphasizes evaluating a patient’s unique dispositions, genetic makeup, life experiences,
beliefs, and more that contribute to their experience of pain.
Rather than focusing solely on biomedical factors, dispositionalism takes a holistic,
biopsychosocial approach. It recognizes that pain is a complex phenomenon involving
biological, psychological, and social factors. As Dr. Vianin explains, pain is inseparable from the
individual experiencing it.
Key Principles of Dispositionalism
There are several key principles of dispositionalism outlined by Dr. Vianin:
Pain is an individualized experience shaped by one’s dispositions. There are no universal rules
about what will cause pain or disability in all people.
Context matters. Pain arises from an interaction between a person’s dispositions and their
environment/context. Alter the context, and you may be able to reduce pain.
Language and meaning influence pain. The words patients use to describe pain and the meaning
they ascribe to it impact their experience.
Focus on enhancing function versus fixing pathology. Pain does not necessarily indicate tissue
damage or pathology. The goal should be improving daily function.
Use shared decision-making. Patients should be actively involved in setting meaningful,
functional goals and planning treatment.
Dispositionalism in Practice
Dispositionalism is starting to transform the clinical encounter between providers and patients
with chronic pain. Instead of a narrow biomedical focus, it promotes a broader discussion about
the patient’s attitudes, beliefs, and values related to their pain.
Providers are encouraged to use empathetic, non-judgmental communication and shared
decision-making. Treatment plans are highly individualized, using modalities like physical
therapy, cognitive behavioral therapy, mindfulness, and hypnosis. The focus is on incremental
improvements in function and quality of life versus “curing” pain.
There is also greater recognition of the social determinants of pain, like poverty, discrimination,
and lack of access to care. Addressing these root causes leads to better outcomes.
The Future of Pain Care
Thanks to the push for more patient-centered care, early results show dispositionalism helps
reduce pain, improve mobility, and increase patient satisfaction. It aligns with other
contemporary pain frameworks like the biopsychosocial model and interdisciplinary pain
management.
As Dr. Vianin writes in his seminal book on dispositionalism, “The experts in pain are the
patients.” Although shifting away from a purely biomedical model is challenging, dispositionalism
offers an exciting new paradigm for treating pain that embraces our complex, multidimensional
humanity.
Grab your copy of Dispositionalism in Musculoskeletal Care to learn more!
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