[en] INTRODUCTION. The biomedical model has dominated the clinical practice of health professionals. Although it is known that it is effective to reach a medical diagnosis, it excludes the possibility that psychosocial factors can influence pain. Therefore, in the 70's, Engel proposes the biopsychosocial model, which attributes the pain experience to biological, psychological, and social factors. The contextual factors related to the physical therapist, the patient, the relationship between them, and the environment, can affect pain in both positive (placebo effect) and negative (nocebo effect) ways. OBJECTIVE. Determine the influence of contextual factors over the therapeutic intervention's outcomes in the patient with chronic pain. MATERIAL AND METHODS. It is a bibliographic review, performed in the databases Pubmed, Scopus, Web of Science, PEDro and Cochrane. The selected articles included those who were randomized or controlled clinical trials, systematic reviews, metanalysis, observational studies or reviews, all of them published in the last 5 years, in English or Spanish, with samples of egressed physical therapists or patients with chronic pain. The search was carried out between January and March of 2021. To manage bibliography, the software Mendeley was used. OUTCOMES. 17 articles were extracted, 14 found in the search and 3 in the systematic reviews. It was observed that the biomedical model is present in physical therapists' attitudes and beliefs. They feel that they are not ready to treat patients by the biopsychosocial model. The therapeutic alliance is a positive aspect for the outcomes of the therapeutic intervention. It is conditioned by multiple factors, such as the improve of the professional's communication skills, empathy, patient's education, trust, or the session's duration. The patient's psychosocial factors can affect in both positive (positive expectations over treatment, improve self-efficacy…) or negative ways (catastrophism, avoid movement…) over treatment outcomes. CONCLUSIONS. The contextual factors have a relevant impact over the therapeutic intervention's outcomes and can have a placebo or nocebo effect, depending on how they are managed by the professional, with the pain experience being the most susceptible to them. Given that, they must be considered to establish the objectives and the intervention itself, embracing the biopsychosocial model in their clinical practice.

[gl] INTRODUCCIÓN. O modelo biomédico dominou, e a día de hoxe, parece que así continúa sendo, a práctica clínica de moitos profesionais da saúde. Aínda que se sabe que é efectivo para chegar a un diagnóstico médico, exclúe a posibilidade de que os factores psicosociais inflúan sobre a dor. Debido a isto, Engel nos anos 70 propón o modelo biopsicosocial, atribuíndo a experiencia dolorosa a factores biolóxicos, psicolóxicos e sociais. Os factores contextuais do fisioterapeuta, o paciente, a relación entre ambos, e o ambiente, poden influír de maneira positiva (efecto placebo) ou negativa (efecto nocebo) sobre a dor. OBXECTIVO. Determinar a influencia dos factores contextuais sobre os resultados da intervención terapéutica no paciente con dor crónica. MATERIAL E MÉTODOS. Trátase dunha revisión bibliográfica realizada nas bases de datos de Pubmed, Scopus, Web of Science, PEDro e Cochrane. Seleccionáronse aqueles artigos presentados como ensaios clínicos aleatorizados ou controlados, revisións sistemáticas, metaanálisis, estudios observacionais e revisións, publicados nos últimos 5 anos, en inglés ou castelán, con mostras de fisioterapeutas egresados ou pacientes con dor crónica. A búsqueda levouse a cabo entre os meses de xaneiro e marzo de 2021. A xestión bibliográfica realizouse mediante o software Mendeley. RESULTADOS. Selecciónanse 17 artigos: 14 da búsqueda, 3 das revisións sistemáticas. Obsérvase que o modelo biomédico está presente nas actitudes e creencias dos fisioterapeutas, sentíndose pouco preparados para abordar os pacientes mediante o modelo biopsicosocial, que resulta máis eficaz para a independencia do paciente. A alianza terapéutica supón un aspecto positivo para os resultados da intervención terapéutica, influíndo en maior medida sobre ela a mellora das habilidades comunicacionais do profesional, a empatía, a educación ó paciente, a confianza, ou o tempo de sesión. Os factores psicosociais do paciente repercuten de maneira positiva (expectativas positivas sobre a intervención, maior autoeficacia…) ou negativa (catastrofismo, evitación do movemento…) sobre os resultados do tratamento. CONCLUSIÓNS. Os factores contextuais inflúen sobre os resultados da intervención terapéutica, e en función de como son modificados polo profesional, poden ter un efecto placebo ou nocebo sobre os resultados da abordaxe (sendo a experiencia dolorosa a máis susceptible a eles), polo que deben terse en conta á hora de establecer os obxectivos e o tratamento.