Difficult medical problems: On explanatory models and a pragmatic alternative

SummaryDespite the significant improvements in the treatment of many pathologic processes witnessed over the past century, some particularly difficult medical problems persist. Some of these problems, perhaps best exemplified by chronic low back pain/degenerative disc disease, are characterized by unclear underlying etiologies and less than desirable outcomes of treatment in spite of considerable intellectual and financial investment. Faced with these disorders, many physicians rely on ‘explanatory models’, such as the traditional Biomedical model or the Biopsychosocial model, to provide a perspective from which to aim research, diagnosis, and treatment programs. The strength of the Biomedical model is its proven success as a roadmap for diagnosis and treatment of a multitude of diseases over the past two centuries. Its weakness lies in its failure to fully include psychosocial factors which have proven to be powerful co-factors of disease in modern society. The Biopsychosocial model has filled this void, but carries with it the potential to blur more straightforward biomedical models of causation (and their straight-forward treatments), questions about whether it is a falsifiable scientific theory, and whether it further ‘medicalizes’ those being treated. In this paper, we expand and detail the strengths and weaknesses of using these explanatory models and conclude by presenting a ‘pragmatic alternative’ hypothesis.