Hand therapists’ perspectives and practices related to musculoskeletal pain: A biopsychosocial lens

Background: While the biopsychosocial model is advocated for pain management, biomedical approaches continue to dominate in practice. Understanding musculoskeletal clinicians’ perspectives and practices related to pain can inform training needs to optimize care. Little is known regarding the viewpoint of hand therapists who may not have exposure to modern pain models. Objective: To explore hand therapists’ perspectives and practices related to musculoskeletal pain using a biopsychosocial lens. Methods: This interpretive descriptive qualitative study was embedded in an explanatory sequential mixed methods design. Thirteen hand therapists in the United States were purposefully sampled based on low and high scores on the Revised Neurophysiology of Pain Questionnaire. Each therapist participated in one semi-structured virtual interview. Data were analyzed using open and a priori codes, which were synthesized into themes that aligned with each domain of the biopsychosocial model. Findings: Participants described “balancing local tissues and the brain,” “empowering through education and function,” and “looking beyond the individual.” Recognition of multidimensional components of pain reinforced participants’ awareness that “pain is always real.” Discussion: Hand therapists appreciated pain as a multidimensional phenomenon, with biological, psychological, and social facets. However, a potential bias toward structural pathology warrants additional training to promote high-value musculoskeletal care.