El estrés enferma: modelo Biopsicosocial del dolor crónico

Dulce Denisse Casillas-Jardon

doi:10.14198/DCN.29572

Autores/as

Dulce Denisse Casillas-Jardon Red Internacional America Latina, Africa, Europa y Caribe (ALEC), México https://orcid.org/0000-0001-6010-1864

DOI:

https://doi.org/10.14198/DCN.29572

Palabras clave:

biopsicosocial, dolor crónico, estrés, epigenética, neuro inflamación

Resumen

El modelo biopsicosocial del dolor representa un enfoque revolucionario para comprender el dolor crónico, superando el reduccionismo biomédico tradicional. Introducido por Engel en 1977 este modelo integra factores biológicos, psicológicos y sociales, revelando la complejidad de la experiencia del dolor. La investigación analiza como el estrés actúa como eje integrador, influenciando la percepción y manifestación del dolor crónico. El objetivo de este artículo es realizar una revisión narrativa sobre el modelo biopsicosocial del dolor crónico. Los hallazgos destacan la interacción dinámica entre sistemas nervioso, endocrino e inmunitario, evidenciando que el dolor no es un fenómeno únicamente físico, sino el resultado de múltiples interacciones. Se identifican procesos críticos como alteraciones del cortisol, neuro inflamación microglial e hipodopaminergia, que demuestran como factores emocionales y sociales pueden desencadenar respuestas fisiológicas similares a lesiones físicas. La epigenética emerge como un campo prometedor para comprender la cronificación del dolor, sugiriendo que experiencias tempranas pueden modificar la expresión genética. El modelo propone estrategias de intervención que incluyen apoyo emocional, información y socialización, reconociendo la naturaleza multidimensional del dolor crónico y la necesidad de enfoques personalizados e interdisciplinarios.

Citas

Engel GL. The need for a new medical model: a challenge for biomedicine. Science [Internet]. 1977 [cited 2025 Feb 5];196(4286):129–36. Available from: https://pubmed.ncbi.nlm.nih.gov/847460/

Selye H. Stress and disease. Science (1979) [Internet]. 1955 Oct 7 [cited 2025 Feb 5];122(3171):625–31. Available from: https://www.science.org/doi/10.1126/science.122.3171.625

Papadimitriou G. The “Biopsychosocial Model”: 40 years of application in Psychiatry. Psychiatriki [Internet]. 2017 Apr 1 [cited 2025 Feb 5];28(2):107–10. Available from: https://pubmed.ncbi.nlm.nih.gov/28686557/

The biopsychosocial approach and considerations involved in chronic pain [Internet]. [cited 2025 Feb 5]. Available from: https://www.longdom.org/articles/the-biopsychosocial-approach-and-considerations-involved-in-chronic-pain.pdf

Lunde CE, Sieberg CB. Walking the Tightrope: A Proposed Model of Chronic Pain and Stress. Front Neurosci [Internet]. 2020 Mar 26 [cited 2025 Feb 5];14:522051. Available from: www.frontiersin.org

Meints SM, Edwards RR. Evaluating Psychosocial Contributions to Chronic Pain Outcomes. Prog Neuropsychopharmacol Biol Psychiatry [Internet]. 2018 Dec 20 [cited 2025 Feb 5];87(Pt B):168. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6067990/

Metcalf BS, Hosking J, Frémeaux AE, Jeffery AN, Voss LD, Wilkin TJ. BMI was right all along: taller children really are fatter (implications of making childhood BMI independent of height) EarlyBird 48. Int J Obes (Lond) [Internet]. 2011 Apr [cited 2025 Feb 5];35(4):541–7. Available from: https://pubmed.ncbi.nlm.nih.gov/21304486/

Mardian AS, Hanson ER, Villarroel L, Karnik AD, Sollenberger JG, Okvat HA, et al. Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care. Pain Med [Internet]. 2020 Jun 1 [cited 2025 Feb 5];21(6):1168–80. Available from: https://pubmed.ncbi.nlm.nih.gov/31909793/

Smith RC, Fortin AH, Dwamena F, Frankel RM. An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Educ Couns. 2013 Jun 1;91(3):265–70.

Tripathi A, Das A, Kar S. Biopsychosocial Model in Contemporary Psychiatry: Current Validity and Future Prospects. Indian J Psychol Med [Internet]. 2019 Nov 1 [cited 2025 Feb 5];41(6):582. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6875848/

Benning TB. Limitations of the biopsychosocial model in psychiatry. Adv Med Educ Pract [Internet]. 2015 [cited 2025 Feb 5];6:347. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4427076/

Tramonti F, Giorgi F, Fanali A. Systems thinking and the biopsychosocial approach: A multilevel framework for patient-centred care. Syst Res Behav Sci [Internet]. 2021 Mar 1 [cited 2025 Feb 5];38(2):215–30. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/sres.2725

Álvarez AS, Pagani M, Meucci P. The clinical application of the biopsychosocial model in mental health: A research critique. Am J Phys Med Rehabil [Internet]. 2012 Feb [cited 2025 Feb 5];91(13 SUPPL.1). Available from: https://journals.lww.com/ajpmr/fulltext/2012/02001/the_clinical_application_of_the_biopsychosocial.24.aspx

Miaskowski C, Blyth F, Nicosia F, Haan M, Keefe F, Smith A, et al. A Biopsychosocial Model of Chronic Pain for Older Adults. Pain Medicine [Internet]. 2020 Sep 1 [cited 2025 Feb 5];21(9):1793–805. Available from: https://dx.doi.org/10.1093/pm/pnz329

Boring BL, Richter A, Mathur VA. Higher self-perceived stress reactivity is associated with increased chronic pain risk. Pain Rep [Internet]. 2023 Mar 22 [cited 2025 Feb 5];8(2):e1068. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10036055/

Jimenez XF. Parallel Pains and Dynamic Dilemmas: Psychodynamic Considerations in Approaching and Managing Chronic Physical Pain. Psychodyn Psychiatry [Internet]. 2019 [cited 2025 Feb 5];47(2):167–82. Available from: https://pubmed.ncbi.nlm.nih.gov/31107168/

Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care [Internet]. 2018 [cited 2025 Feb 5];7(3):497. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6069638/

Baria AM, Pangarkar S, Abrams G, Miaskowski C. Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans. Pain Medicine [Internet]. 2019 Jan 1 [cited 2025 Feb 5];20(1):14–27. Available from: https://dx.doi.org/10.1093/pm/pny058

Novy DM, Aigner CJ. The biopsychosocial model in cancer pain. Curr Opin Support Palliat Care [Internet]. 2014 [cited 2025 Feb 5];8(2):117–23. Available from: https://journals.lww.com/co-supportiveandpalliativecare/fulltext/2014/06000/the_biopsychosocial_model_in_cancer_pain.6.aspx

Wippert PM, Wiebking C. Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment. Int J Environ Res Public Health [Internet]. 2018 Apr 18 [cited 2025 Feb 5];15(4):785. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5923827/

Ettlin DA, Napimoga MH, Meira e Cruz M, Clemente-Napimoga JT. Orofacial musculoskeletal pain: An evidence-based bio-psycho-social matrix model. Neurosci Biobehav Rev [Internet]. 2021 Sep 1 [cited 2025 Feb 5];128:12–20. Available from: https://pubmed.ncbi.nlm.nih.gov/34118294/

Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med [Internet]. 2002 Sep [cited 2025 Feb 5];64(5):773–86. Available from: https://pubmed.ncbi.nlm.nih.gov/12271108/

Kikuchi S. New concept for backache: biopsychosocial pain syndrome. European Spine Journal [Internet]. 2008 Dec [cited 2025 Feb 5];17(Suppl 4):421. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2587659/

Fillingim RB. Individual differences in pain: Understanding the mosaic that makes pain personal. Pain [Internet]. 2017 [cited 2025 Feb 5];158(4):S11–8. Available from: https://journals.lww.com/pain/fulltext/2017/04001/individual_differences_in_pain__understanding_the.3.aspx

Vega E, Beaulieu Y, Gauvin R, Ferland C, Stabile S, Pitt R, et al. Chronic non-cancer pain in children: we have a problem, but also solutions. Minerva Anestesiol [Internet]. 2018 Sep 1 [cited 2025 Feb 25];84(9):1081–92. Available from: https://pubmed.ncbi.nlm.nih.gov/29745621/

Overstreet DS, Pester BD, Wilson JM, Flowers KM, Kline NK, Meints SM. The Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment. Curr Pain Headache Rep [Internet]. 2022 Jan 1 [cited 2025 Feb 25];27(1):1. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10683048/

Polatin PB, Young M, Mayer M, Gatchel R. Bioterrorism, stress, and pain: The importance of an anticipatory community preparedness intervention. J Psychosom Res [Internet]. 2005 Apr [cited 2025 Feb 25];58(4):311–6. Available from: https://pure.johnshopkins.edu/en/publications/bioterrorism-stress-and-pain-the-importance-of-an-anticipatory-co-3

Pérez Martín Y, Pérez Muñoz M, García Ares D, Fuentes Gallardo I, Rodríguez Costa I. El cuerpo duele, y el dolor social… ¿duele también? Aten Primaria. 2020 Apr 1;52(4):267–72.

Finestone HM, Alfeeli A, Fisher WA. Stress-induced physiologic changes as a basis for the biopsychosocial model of chronic musculoskeletal pain: a new theory? Clin J Pain [Internet]. 2008 [cited 2025 Feb 25];24(9):767–75. Available from: https://pubmed.ncbi.nlm.nih.gov/18936594/

Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and Emotion: A Biopsychosocial Review of Recent Research. J Clin Psychol [Internet]. 2011 Sep [cited 2025 Feb 25];67(9):942. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3152687/

Van Houdenhove B, Egle UT. Fibromyalgia: A stress disorder? Piecing the biopsychosocial puzzle together. Psychother Psychosom. 2004;73(5):267–75.

Al-Khotani A, Naimi-Akbar A, Gjelset M, Albadawi E, Bello L, Hedenberg-Magnusson B, et al. The associations between psychosocial aspects and TMD-pain related aspects in children and adolescents. J Headache Pain [Internet]. 2016 Dec 1 [cited 2025 Feb 25];17(1):30. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4820412/

Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V. Psychometric Profiles and HPA Axis Function in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). J Urol [Internet]. 2008 Mar [cited 2025 Feb 25];179(3):956. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2694575/

Montoya Navarro A, Sánchez Salazar CA, Krikorian A, Campuzano Cortina C, López Marín M. Sufrimiento en pacientes con fibromialgia y su relación con el impacto en la calidad de vida, la soledad, el estado emocional y el estrés vital. Revista Colombiana de Reumatología [Internet]. 2024 Apr 1 [cited 2025 Feb 25];31(2):193–204. Available from: https://www.elsevier.es/es-revista-revista-colombiana-reumatologia-374-articulo-sufrimiento-pacientes-con-fibromialgia-su-S0121812323000324

Wickrama K, Klopack ET, O’Neal CW. Higher-order Trajectories of Pain and Depressive Symptoms Link Midlife Financial Stress to Women’s Well-being in Later Life. Aging Ment Health [Internet]. 2021 [cited 2025 Feb 25];26(12):2358. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9152740/

Schemitsch C, Nauth A. Psychological factors and recovery from trauma. Injury [Internet]. 2020 May 1 [cited 2025 Feb 25];51 Suppl 2:S64–6. Available from: https://pubmed.ncbi.nlm.nih.gov/31676072/

Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. BJA: British Journal of Anaesthesia [Internet]. 2013 [cited 2025 Feb 25];111(1):52. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3690315/

Wickrama K, Klopack ET, O’Neal CW. Higher-order Trajectories of Pain and Depressive Symptoms Link Midlife Financial Stress to Women’s Well-being in Later Life. Aging Ment Health [Internet]. 2021 [cited 2025 Feb 25];26(12):2358. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9152740/

McLean SA, Clauw DJ, Abelson JL, Liberzon I. The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model. Psychosom Med [Internet]. 2005 [cited 2025 Feb 25];67(5):783–90. Available from: https://pubmed.ncbi.nlm.nih.gov/16204439/

Gevers-Montoro C, Liew BXW, Deldar Z, Conesa-Buendia FM, Ortega-De Mues A, Falla D, et al. A network analysis on biopsychosocial factors and pain-related outcomes assessed during a COVID-19 lockdown. Sci Rep [Internet]. 2023 Dec 1 [cited 2025 Feb 25];13(1):4399. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10019800/

Anderson RU, Orenberg EK, Morey A, Chavez N, Chan CA. Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol [Internet]. 2009 Nov [cited 2025 Feb 25];182(5):2319–24. Available from: https://pubmed.ncbi.nlm.nih.gov/19762053/

Søegaard EGI, Kan Z, Aass HCD, Koirala R, Hauff E, Thapa SB. Abnormal Cytokines in Trauma Patients Explained by Obesity, Musculoskeletal Disease, Smoking, and Lung Disease. Neuropsychobiology [Internet]. 2022 Dec 1 [cited 2025 Feb 25];81(6):516–30. Available from: https://pubmed.ncbi.nlm.nih.gov/36302340/

Golanska P, Saczuk K, Domarecka M, Kuć J, Lukomska-Szymanska M. Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review. Int J Environ Res Public Health [Internet]. 2021 Aug 1 [cited 2025 Feb 25];18(15). Available from: https://pubmed.ncbi.nlm.nih.gov/34360099/

Borsook D, Linnman C, Faria V, Strassman AM, Becerra L, Elman I. Reward deficiency and anti-reward in pain chronification. Neurosci Biobehav Rev [Internet]. 2016 Sep 1 [cited 2025 Feb 25];68:282–97. Available from: https://pubmed.ncbi.nlm.nih.gov/27246519/

Delgado-Sanchez A, Brown C, Sivan M, Talmi D, Charalambous C, Jones AKP. Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models. J Pain Res [Internet]. 2023 [cited 2025 Feb 25];16:3145–66. Available from: https://pubmed.ncbi.nlm.nih.gov/37727681/