Psychological mislabeling of chronic pain: lessons from migraine in the 20th century.

Starting with Freud, psychoanalytically oriented practitioners described a complex of unconscious conflicts, desires and personality traits they believed to be the primary cause of a wide range of medical disorders. This was the psychogenic model. With the advance of basic research and pharmacotherapy, the psychogenic model was gradually replaced by a biopsychobehavioral model. This model treats chronic pain as a biologically based disorder that can be influenced by psychological factors and lifestyle. The present paper argues that many patients with chronic pain may not be significantly impacted by psychological factors, and that for those who are, cognitive-behavioral therapy is the treatment of choice.