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Cited by 116Psychosomatic Disorders and Their TreatmentsMusculoskeletal pain and rehabilitationPain Management and Treatment

Psychological therapy for centralized pain: an integrative assessment and treatment model

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Lumley, Mark A., Schubiner, Howard·2019·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000654PMC PMC6355353
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Abstract

Objective: Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. Methods: We briefly review the leading evidence-based psychological therapies for chronic pain—cognitive-behavioral and acceptance/mindfulness-based therapies—and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges. Results: Greater pain treatment efficacy may be possible if clinicians: ( a ) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; ( b ) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; ( c ) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and ( d ) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. Conclusions: This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.

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  • Psychotherapies focusing on early life adverse experiences, unexplored conflicting emotions and beliefs, and their effect on current and future behaviour are relatively undeveloped in chronic pain management but trials are now emerging.

    “They are relatively undeveloped in chronic pain management but trials are now emerging (Lumley 2019).”

    From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Lumley 2019

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Authors
Lumley, M. A., & Schubiner, H.
Affiliations
  • Wayne State University (US)
  • Ascension (US)
Corresponding author
Lumley, Mark A.
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-02
Volume
81
Issue
2
Pages
114-124
ISSN
  • 0033-3174 (ISSN-L)
  • 1534-7796
DOI
10.1097/psy.0000000000000654
PMC
PMC6355353
OpenAlex
W2901480911
Cited by
116
References
95
Citations by year
2026: 22 · 2025: 21 · 2024: 10 · 2023: 18 · 2022: 17 · 2021: 11 · 2020: 9 · 2019: 8
FWCI
1.06
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR057808)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
chronic pain, psychotherapy, nociplastic pain, somatoform pain, pain neuroscience education, cognitive behavioral therapy, emotional avoidance, trauma, interpersonal stress, pain assessment
MeSH terms
Humans, Psychotherapy, Chronic Pain

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