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If you’ve ever asked yourself, “Why does my pain still exist even though my scans are normal?” or “Why hasn’t my back pain improved despite treatment?”, you’re not alone.
At Anandi’s Physiotherapy, we see many people who come in frustrated, tired, and sometimes even hopeless after months or years of living with pain. Especially with conditions like chronic low back pain, the answers aren’t always simple. Pain doesn’t always behave the way we expect it to.
This is exactly where the Pain and Disability Drivers Management (PDDM) Model becomes incredibly important.
Developed by Canadian researcher Yannick Tousignant-Laflamme, the PDDM model helps rehabilitation professionals move beyond a “one-size-fits-all” approach and instead understand why pain and disability persist in each individual.
Let’s break this down in a way that actually makes sense.
Why Traditional Pain Approaches Often Fall Short
Historically, non-specific low back pain, along with other musculoskeletal issues, was approached primarily from a structural standpoint: muscles, joints, discs, posture or movement patterns.
But consider this:
Pain is not simply a physical condition; it’s a human experience.
This is why understanding how to effectively manage pain and disability drivers is critical (PDDM model).
By thinking on behalf of our clients every day, we anticipate what they want, provide what they need & build lasting relationships. These are the concept that shape our distinctive culture & differentiate us from others.
What Is the Pain and Disability Drivers Management (PDDM) Model?
The Pain and Disability Drivers Management (PDDM) Model is a clinical reasoning framework developed to guide therapists in identifying what truly drives a person’s pain and disability, not simply guessing or relying exclusively on a label.
The PDDM Model looks at a person’s pain through three dimensions:
For each of these three dimensions, the PDDM Model has five key domains that impact recovery.
The Five Key Domains of the PDDM Model
1. Nociceptive Drivers (Tissue-Related Pain)
This is what people generally understand and associate with pain: the physical manifestation of injuries, damage to muscles, irritation of joints and pressure on discs or ligaments, as well as inflammation.
These are often mechanical and movement-related and usually respond well to:
In the PDDM model, these are often placed in the inner circle (A) because they are more common and modifiable.
2. Nervous System Dysfunction Drivers
Sometimes pain isn’t coming from damaged tissue; it’s coming from an over-sensitive nervous system.
This can include:
As Tousignant-Laflamme famously explained:
“If you want to sensitise somebody’s nervous system, let the pain be there and do nothing about it.”
Managing this requires:
3. Comorbidity Drivers
Pain doesn’t exist in isolation. Conditions like:
can slow recovery and increase pain intensity.
In the PDDM model, more complex comorbidities fall into the outer circle (B), meaning they may require interdisciplinary care alongside physiotherapy.
4. Cognitive-Emotional Drivers
This is one of the most overlooked and most powerful pain drivers. These include:
Pain becomes stronger when the brain perceives a threat. At Anandi’s Physiotherapy, addressing these drivers means:
5. Contextual Drivers
Life matters. These drivers include:
A person’s environment can either support recovery or constantly challenge it. The PDDM model reminds clinicians to treat the person, not just the symptoms.
The Five Key Domains of the PDDM Model
Each domain in the PDDM model has:
Inner circle (A): More common, modifiable drivers
Outer circle (B): Complex drivers that may require longer-term or interdisciplinary management
This helps therapists decide:
How the PDDM Model Is Used in Rehabilitation
The Pain and Disability Drivers Management approach begins with a structured assessment, often using:
Yannick Tousignant-Laflamme and his team also developed a PDDM rating scale, helping clinicians systematically assess each domain.
The result? A personalised rehabilitation plan, not a generic protocol.
Why This Matters for Patients
For patients, the PDDM model means:
This approach shifts rehab from “fixing” to understanding, supporting, and empowering.
Challenges in Using the PDDM Model
The biggest challenges include:
But the payoff is worth it.
The Opportunity for Better Care
The model of Pain and Disability Drivers Management incorporates:
At Anandi’s, we believe this is exactly how we provide/approach Rehabilitation by using an Evidence-Based Approach combined with Empathy and individualised care.
Conclusion:
Pain is usually not limited to just the muscles or joints, and as shown in this model, pain is thought to involve Biological, Psychological and Social aspects. By looking deeper at what is actually causing the pain/disability, the Rehabilitation Process will be Better understood, More Respectful and can be much more effective.
As far as patients who have not been heard or have been misunderstood in the past, when they begin to see what the issues are, it helps to clarify things and gives them a Better chance of achieving their expectations of Recovery.
Pain is not simply a physical condition; it’s a human experience.
