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Chronic Pain: Healing Cycle, Treatment & Biopsychosocial Model

What is ASTR?

Advanced Soft Tissue Release (ASTR) is the new technology that works on the principle of releasing soft tissues for the treatment of chronic pain by considering the source of the problem instead of symptoms with the help of several instruments of physiotherapy. This article has reviewed the current treatments for chronic pain patients, highlighted the most effective treatments, discovered the 10 elements to relieve chronic pain, and the treatment solutions to most of the problems. To cover these, several research studies have been reviewed and presented in this article to provide evidence-based treatment solutions through ASTR.

Current Treatments For Chronic Pain

The current treatments to reduce chronic pain include massage, acupuncture, spine adjustment, dry needle, joint mobilization, manual therapies, exercises, and stretching, which provide short-term pain relief instead of long-term. The University of Ottawa, in Canada systematically reviewed 270 studies, and found that massage, acupuncture, and spine adjustment only provide short-term pain relief as its effects are faded over time [1]. Another systematic review observed the outcomes of manual therapy and spine adjustment and reported that these treatment interventions provide short-term pain relief across different outcomes related to chronic pain, subacute neck pain with or without cervicogenic pain [2]. Besides these two, multiple studies revealed that treatments like massage, stretching, joint mobilization, spine adjustments, and others provide short-term relief because they fade up the symptoms, but the actual cause of the disease remains the same due to which the pain associated with the diseases is reversed back within few hours, weeks, or months [3]. There is a greater need to provide effective treatment solutions for people suffering from chronic pain. Chronic pain is associated with the healing mechanism of a body in response to a cause of pain. Therefore, it is important to understand the normal healing mechanism of the body [4].

Normal Healing Cycle

The normal healing cycle is a complex process that involves a cascade of several events when a body detects any injury or tear in any area. To understand this mechanism simply, let’s take an example of an external cut. When there is a cut on the external layer of the skin, three stages of the healing cycle occur including inflammation, proliferation, and maturation. The inflammation is started with the rushed flow of blood to the injured area and there is sudden redness, swelling, increased temperature, and tenderness at the site of injury due to the increased blood circulation in the area. The second is the proliferation stage in which the cascade of events occurs including scar tissue formation, fascia restrictions, muscle spasms, and trigger points. The scar tissue formation is the most critical event that is a connective tissue to cover the injured area so that the open wound could not be susceptible or exposed to any infection or bacteria. The fascia restriction is based on the formation of superficial and deep layers of fascia tissues that build up new layers to heal the wound. The scar tissue and the fascia need to be released to reach the maturation stage in which the wound is completely healed and the cut is closed by the new skin and fascia layers. However, the ability to release scar tissue and fascia is decreased over time due to which the body is unable to reach the maturation stage that leads to chronic pain [5]. 

10 Elements to Relieve Pain

Chronic pain is associated with different factors therefore the elements to relieve pain are also varied. For example, if a person had an accident and had a jerk in the neck due to which there are micro-tears in the neck muscles causing chronic pain in his neck. The first response of the body will be the inflammation in the neck muscles to increase blood circulation in the tears of the neck muscles. The second stage of proliferation is started simultaneously to form the scar tissue, fascia restriction, muscle spasm, and trigger points. But that would not help him in stopping pain because the micro-tears in the neck muscles are not healed. This would lead to wrong posture and poor body mechanics because he would not be able to stand, sit, or work for longer hours. Eventually, his gait will also be affected due to neck pain protruding towards the spine. This would also affect his diet, give him anxiety and stress, and lifestyle changes. Therefore, it can be summarized that the 10 elements to relieve pain include inflammation, scar tissue, muscle spasm, fascia restriction, trigger points, poor posture, and body mechanics, gait, stress and anxiety, diet, and lifestyle and these elements are needed to be treated simultaneously for long-term pain relief [6].

Biopsychosocial Approach

The biopsychosocial model was developed in 1977 by Dr. George Angel that impressively linked all these 10 elements of chronic pain in the form of physical, psychological, and social factors that contribute to chronic pain relief. This model provides the foundation of treating chronic pain patients ergonomically, medically, massaging, releasing soft tissue, meditating, managing stress, and nutrition to treat the pain [7].

The application of this model requires multi-disciplinary practice as it requires different professionals to work coordinated to provide pain relief. A systematic review by Guzman found that the biopsychosocial model is effective in the functional improvement of a patient as compared to the non-multidisciplinary team [8].

ASTR is the reinvention of the biopsychosocial model and multidisciplinary approach in which a patient has not to visit different practitioners for multi-disciplinary practice but the treatment is provided for chronic pain patients in a few therapies that usually last for 2-3 sessions of massage, physical exercise, ergonomics, soft tissue release, and diet. The effects of ASTR are evident by the improvement in chronic pain, improved body postures, improved gait, and improved joint movements in a short time.


  1. Brosseau L, Wells GA, Tugwell P, Casimiro L, Novikov M, Loew L, Sredic D, Clément S, Gravelle A, Hua K, Kresic D. Ottawa panel evidence-based clinical practice guidelines on therapeutic massage for neck pain. Journal of Bodywork and Movement Therapies. 2012 Jul 1;16(3):300-25.
  2. Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. Journal of back and musculoskeletal rehabilitation. 2017 Jan 1;30(6):1149-69.
  3. Martorella G. Characteristics of nonpharmacological interventions for pain management in the ICU: a scoping review. AACN advanced critical care. 2019;30(4):388-97.
  4. Ward RE, Sklar LR, Eisen DB. Surgical and noninvasive modalities for scar revision. Dermatologic clinics. 2019 Jul 1;37(3):375-86.
  5. Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. Journal of International Medical Research. 2009 Oct;37(5):1528-42.
  6. Wiewelhove T, Schneider C, Döweling A, Hanakam F, Rasche C, Meyer T, Kellmann M, Pfeiffer M, Ferrauti A. Effects of different recovery strategies following a half-marathon on fatigue markers in recreational runners. PLoS One. 2018 Nov 9;13(11):e0207313.
  7. Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. Journal of family medicine and primary care. 2018 May;7(3):497.
  8. Engel GL. The clinical application of the biopsychosocial model. InThe Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 1981 Jan 1 (Vol. 6, No. 2, pp. 101-124). Oxford University Press.

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