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A biopsychosocial formulation for chronic pain — mapping biological, psychological, and social maintaining factors.
Chronic pain is maintained by the interaction of biological factors (the body), psychological factors (thoughts, emotions, behaviours), and social factors (relationships, work, role changes). Map each component with your therapist.
Use in the assessment and formulation phase of CBT for chronic pain. The formulation maps the cognitive, emotional, behavioural, and physiological factors maintaining pain-related disability and distress, moving beyond a purely biomedical understanding.
Validate the client's pain as real before introducing the formulation model. Explain that the formulation examines what factors amplify pain and disability, not whether the pain is 'real' or 'in their head.' Use the biopsychosocial framework to show how thoughts, emotions, and behaviours interact with physical pain signals.
For clients who are sceptical about psychological approaches to pain, spend more time on psychoeducation about pain neuroscience (gate control theory, central sensitisation) before formal formulation. For those with comorbid depression, map the interaction between pain and low mood explicitly.
If the client perceives the formulation as invalidating their physical pain or implying it is psychosomatic, slow down and address this directly. Do not proceed with psychological formulation if the client has not had adequate medical assessment and management of their pain condition.
Common maintaining factors in chronic pain include fear-avoidance beliefs, catastrophising, boom-bust activity patterns, deconditioning, sleep disruption, and social withdrawal. The formulation should highlight these as targets for intervention while validating the client's experience of pain.
Suitable for clients working with chronic pain, formulation, biopsychosocial, cbt, pain management. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Plan a gradual, time-based increase in activity from a sustainable baseline — not guided by pain, but by a pre-set schedule.
Create a plan for managing pain flare-ups — covering prevention, early action, and what to do at each level of severity.
Track pain levels alongside activity, mood, and coping strategies to identify patterns.
Identify and challenge catastrophic thoughts about pain — helplessness, magnification, and rumination.