The Emerging Role of the Biopsychosocial-Enactive Model in Chiropractic Care for Chronic Low Back Pain

Chronic low back pain (CLBP) is a prevalent problem affecting Australians and the world over (1).

It challenges healthcare professionals, including chiropractors. Traditional treatment approaches often focus heavily on biomedical methods.

However, recent insights suggest a more integrative framework might be beneficial.

This article gets into the integration of the biopsychosocial-enactive (BPS-E) model within chiropractic care, offering a comprehensive perspective on pain management that considers the biological, psychological, and social dimensions of health.

Understanding the BPS-E Model

The BPS-E model is an evolution of the traditional biopsychosocial (BPS) framework. While the BPS model recognises the multifactorial nature of pain, it has been critiqued for its often fragmentary application in healthcare settings (Bianchi et al., 2025).

Typically, biological aspects are prioritised over psychological and social factors, leading to a compartmentalisation that doesn't fully address the complexities of pain. The BPS-E model expands on this by incorporating enactivism, a perspective that emphasises the intrinsic connection between individuals and their environments in the manifestation of pain.

This approach views pain as an emergent, dynamic process influenced by the interplay between mind, body, and context.

Application in Chiropractic Care

Incorporating the BPS-E model into chiropractic care requires adopting a holistic approach that emphasises patient-centred care.

● Focus on entire human not individual aspects within the body

● Consider physical, psychological, and social factors contributing to pain

● Understand the patient's lived experiences and personal goals

● Acknowledge environmental influences on patient's health

● Offer tailored and effective interventions for chronic low back pain (CLBP)

Advantages of the BPS-E Approach

One of the standout advantages of the BPS-E model is its holistic nature. It encourages chiropractors to see patients as whole individuals rather than a set of isolated symptoms.

A study by Bianchi et al. (2025) highlights how this model can lead to significant improvements in patient outcomes by fostering a deeper understanding of their pain experiences. This holistic perspective also aligns well with contemporary theories of pain that focus on its embodied and dynamic character, rather than viewing it as a purely biological phenomenon.

Challenges and Considerations

Despite its benefits, the integration of the BPS-E model in practice is not without challenges. Chiropractors may need additional training to effectively apply this model, which can be resource-intensive. Moreover, it requires a paradigm shift from traditional methods, necessitating a restructuring of treatment approaches and patient assessments.

Conclusion

The BPS-E model presents a promising framework for enhancing chiropractic care in managing CLBP. By offering a more comprehensive understanding of pain, incorporating this model could lead to better patient outcomes and more effective pain management strategies.

Further research and ongoing education are essential to facilitate the widespread adoption of this promising approach.

References

1. https://www.who.int/news-room/fact-sheets/detail/low-back-pain

2. Bianchi, M., Rossettini, G., Cerritelli, F., & Esteves, J. E. (2025). Insights into how manual therapists incorporate the biopsychosocial-enactive model in the care of individuals with CLBP: a qualitative study. Chiropractic & Manual Therapies, 33(1). https://doi.org/10.1186/s12998-025-00574-3