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Somatoform pain disorder: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
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A pain disorder is characterized by pain in one or more anatomical sites severe enough to cause distress or impairment of social, occupational, or other functioning. Psychological factors are thought to play a dominant role in the onset, severity, exacerbations, and persistence of symptoms, but the pain is not intentionally induced or feigned. Some patients can recall an initial trigger for acute pain. Diagnosis is based on history. Treatment begins with the establishment of a strong, supportive physician-patient relationship; psychotherapy may also be helpful.
The proportion of people whose chronic pain is due to psychological factors is unknown. However, pain is rarely defined as "all in the patient's head"; pain apperception includes sensory and emotional components.
[ Symptoms of somatoform pain disorder
Pain due to psychological factors is common in mood and anxiety disorders, but is the main complaint in pain disorders. The pain may be located anywhere in the body, but is most common in the back, head, abdomen, and chest. The pain may be acute or chronic (>6 months). The underlying disease or injury may explain the pain, but not its severity, duration, or the degree of disability it causes.
The diagnosis is based on the history after exclusion of any medical disorder that could adequately explain the pain and its severity, duration, and degree of disability. Identification of psychiatric or social stressors may help to explain the disorder.
Treatment of somatoform pain disorder
A thorough medical evaluation followed by strong reassurance may be sufficient. Sometimes, pointing out the relationship to obvious mental and social stressors is effective. However, many patients have chronic and very difficult-to-treat problems. Patients are reluctant to associate their problems with psychosocial stressors and usually refuse psychotherapy. They may see many doctors, expressing a desire for treatment, and are at risk for developing dependence on opioids and benzodiazepines. Careful, regular reassessments by an attentive physician who remains alert to the possibility of developing a new significant physical illness while sparing the patient from unnecessary and potentially costly or dangerous tests or procedures are the best chance of obtaining long-term relief.