MEDICO-LEGAL POSITION STATEMENT
Neurophysiological Basis of Pain and the Biopsychosocial Model
Pain 2 Wellness Chiropractic Center & Brain and Bodily Injury Centers
Prepared by:
Dr Winston Carhee, DC
Pain 2 Wellness Chiropractic Center & Brain and Bodily Injury Centers
Atlanta, Georgia
Executive Summary
Modern neuroscience establishes that pain is a neurophysiological output of the brain influenced by biological, psychological, and social factors. Pain is real and measurable, but its severity and persistence do not correlate solely with structural tissue damage. This understanding forms the basis of the biopsychosocial (BPS) model, which is the internationally accepted framework for evaluating and treating acute and chronic pain.
Pain 2 Wellness Chiropractic Center and Brain and Bodily Injury Centers utilize evidence-based, non-invasive, mechanism-focused care consistent with current clinical guidelines, neuroscience research, and medico-legal standards.
Scientific Foundation
- Pain is produced by the central nervous system
The International Association for the Study of Pain (IASP), the global authority on pain science, defines pain as:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
(IASP, 2020)
The IASP further clarifies that pain is always a personal experience influenced by biological, psychological, and social factors, and pain cannot be inferred solely from tissue injury.
Clinical implication: Pain is generated by the brain after evaluating sensory input, threat perception, prior experience, and context.
- Structural abnormalities often do not correlate with pain severity
A systematic review published in American Journal of Neuroradiology found that disc degeneration, bulging discs, and other spinal findings are highly prevalent in asymptomatic individuals and increase with age.
(Brinjikji et al., 2015)
Medico-legal implication: Imaging findings alone cannot determine the presence, severity, or functional impact of pain.
- Many persistent pain conditions involve altered nervous system processing (nociplastic pain)
IASP recognizes “nociplastic pain” as pain arising from altered nociception without clear evidence of ongoing tissue damage or nerve injury.
(Kosek et al., IASP, 2017)
This reflects central sensitization, where the nervous system amplifies pain signaling independent of structural injury severity.
- Psychological and cognitive factors directly influence pain intensity and disability
Research demonstrates that fear, stress, expectation, and cognitive interpretation significantly affect pain severity, recovery time, and functional outcomes.
(Vlaeyen & Linton, Pain, 2000)
These factors are measurable, physiological contributors—not psychological fabrication.
- Clinical guidelines support non-invasive biopsychosocial treatment approaches
Major clinical guidelines, including those from the National Institute for Health and Care Excellence (NICE), recommend non-invasive, multidisciplinary approaches addressing neurological, functional, and psychosocial contributors to pain.
(NICE Guideline NG193, 2021)
Clinical and Legal Implications
Based on current scientific evidence:
- Pain is real and neurophysiologically generated by the brain.
- Pain severity does not correlate solely with imaging or structural findings.
- Persistent pain frequently involves nervous system sensitization.
- Psychological and social factors influence measurable physiological pain responses.
- Evidence-based treatment must address neurological, functional, and psychosocial contributors.
Application to Clinical Care at Pain 2 Wellness and Brain and Bodily Injury Centers
Our clinical model is consistent with internationally accepted standards and includes:
- Objective neurological and functional assessment
- Evidence-based conservative treatment
- Functional restoration and rehabilitation
- Patient education to reduce maladaptive pain processing
- Outcome-based clinical monitoring
This approach is designed to restore neurological function, reduce pain sensitization, and improve functional capacity.
Medico-Legal Conclusion
Current scientific and clinical consensus establishes that pain is a complex neurophysiological experience influenced by multiple factors beyond structural injury alone.
Therefore:
- Persistent pain is medically legitimate even when imaging findings are limited.
- Conservative, non-invasive biopsychosocial care is medically necessary and appropriate.
- Treatment addressing neurological and functional contributors is consistent with accepted standards of care.
Key References
International Association for the Study of Pain (IASP). Revised Definition of Pain. 2020.
Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2015.
Kosek E, et al. Chronic nociplastic pain definition and clinical implications. IASP. 2017.
Vlaeyen JW, Linton SJ. Fear-avoidance model of chronic pain. Pain. 2000.
National Institute for Health and Care Excellence (NICE). Chronic Pain Guideline NG193. 2021.