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Archived Comments for: The biopsychosocial model and chiropractic: a commentary with recommendations for the chiropractic profession

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  1. Comment on: The biopsychosocial model and chiropractic: a commentary with recommendations for the chiropractic profession

    Username: chirokatie, Disqus ID: chirokatie

    15 August 2017

    We recently read the Gliedt et al.,1 article “The biopsychosocial model and chiropractic: a commentary with recommendations for the chiropractic profession“ in the journal, Chiropractic and Manual Therapies. We wish to commend the authors on writing an article to present an overview of the biopsychosocial (BPS) model and to discuss the BPS model in the context of its place with clinical chiropractic practice.

    Whilst a PuBMed search of “chiropractic”, “psychosocial” and “psychological” produced a total of approximately 184 articles, we feel an article that we published in 2006, that is highly relevant to the discussion of the BPS model and chiropractic was overlooked. As the authors of an article titled “Biopsychosocial model of pain and its relevance to Chiropractors”,2 we wish to bring this article to the attention of the Gliedt et al.,1 and the broader consumers of chiropractic literature. Published 11 years ago, this narrative review was the first of its kind to comprehensively discuss the multi-factorial experience of pain, and principles such as avoidance behaviour and operant and cognitive behavioural approaches. Furthermore, the paper carefully introduced the physiological stress response; discussing the three stages Selye’s general adaptation syndrome (alarm, resistance and exhaustion), and how, when responding to stress, prolonged activation of the hypothalamic-pituitary-adrenocortical axis and the sympathetic-adrenal-medullary axis may contribute to chronic pain. Finally, the review explored patient centered care, with specific acknowledgement that “The application of the BPS model of pain to chiropractic management approaches will allow practitioners to fully appreciate the scope of the disability, impairment, and underlying pathology commonly presenting to them.” Additionally, this paper was one of a series of four that were written to explore the issues associated with non musculoskeletal effects of chiropractic.

    Pollard)3 attempted to describe the somatovisceral reflex and its limitations as an explanation for all effects observed by chiropractors following treatment. Pollard4 attempted to show that many of the systemic disorders treated by chiropractors are associated with psychosocial factors that are expressed through supraspinal influences rather than somatovisceral ones. Hardy & Pollard2 provided a commentary on the mechanism for the proposed supraspinal influences on disease using the stress mechanism and Pollard et al5, collectively discussed the previous three papers in a clinical framework of the BPS model. The BPS model is one that better represents a broader rather than traditional model of aberrant somatovisceral reflexes that many chiropractors typically adopt in a describing the effects of their therapy.

    The article by Gliedt et al.,1 is a contemporary commentary on the BPS in the fields of spine and pain care. We support their call for research to implement the BPS model within the chiropractic encounter, and within multi-disciplinary management teams. The discussion of the context of the BPS model within chiropractic education and practice is valuable and should be embraced by the profession. However, it is with some disappointment that the authors of the current commentary have failed to identify pertinent chiropractic literature that is highly relevant to their topic of discussion.

    1.Gliedt JA, Schneider MJ, Evans MW, King J and Eubanks JE, Jr. The biopsychosocial model and chiropractic: a commentary with recommendations for the chiropractic profession. Chiropractic & manual therapies. 2017; 25: 16.

    2.Pollard H, K Hardy, D Curtin. Biopsychosocial Model of Pain and Its Relevance to Chiropractors. Chiropr J Aust 2006; 36: 82-91.

    3.Pollard H. The Somatovisceral Reflex: How Important for the "Type O" Condition? Chiropr J Aust 2004; 34: 93-102.

    4.Pollard H. Reflections on the "type O" disorder. J Manipulative Physiol Ther. 2005; 28(7): 547.

    5.Hardy K, Pollard H. The organisation of the stress response, and its relevance to chiropractors: a commentary. Chiropr Osteopat. 2006; 14: 25.

    Competing interests


  2. Reply to: chirokatie

    Username: Jordan Gliedt, DC, Disqus ID: jordangliedtdc

    22 August 2017

    We would like to thank Pollard, et al. for their interest in
    this topic and support of our recommendations. We failed to identify Pollard’s
    article [1] in our literature search because it was published in a non-indexed
    journal. It is important to recognize that we did not, nor did we claim to,
    perform a comprehensive systematic review of the literature, which included
    “grey literature”. We are pleased that these authors have published a prior
    article which also highlights the applicability of the biopsychosocial approach
    in chiropractic practice [1].


    Jordan Gliedt, DC

    1. Pollard H, Kardy K, Curtin D. Biopsychosocial model of
    pain and its relevance to chiropractors. Chiropr J Aust. 2006; 36: 82-91.

    Competing interests