Psychosomatic pain

What is important to know

Dividing pain into exclusively “physical” and exclusively “psychological” often oversimplifies the situation.

For example, pain may initially occur after an injury or illness but persist longer than expected. Chronic pain, in turn, can disrupt sleep, reduce activity, increase anxiety, and worsen mood. These changes can further increase sensitivity to pain and make recovery more difficult.

For some people, stress is accompanied by increased muscle tension, poor sleep, and an increase in existing pain. However, stress is not necessarily the original cause of pain.

How can it manifest itself?

A person may notice:

prolonged or recurring pain without a simple and obvious cause;

changes in pain intensity at different periods;

increased symptoms during times of stress or lack of sleep;

combination of pain with severe fatigue;

muscle tension;

sleep disorders;

increased sensitivity to touch or physical activity;

anxiety due to bodily sensations;

constant monitoring of symptoms and fear of their intensification;

reducing activity for fear of causing new pain;

worsening mood due to prolonged pain.

The presence of these signs does not in itself indicate a psychological cause of pain.

What to pay attention to

When did the pain first appear and what happened during this period.

Whether there is an established disease, injury or other medical reason.

Where is the pain located and does its location change?

What is its character: aching, burning, pressing, shooting or another.

Is the pain constant or occurs in episodes?

What increases and what decreases symptoms.

How pain is related to sleep and physical activity.

Does its intensity change during periods of severe stress?

Is there anxiety, depressed mood, emotional exhaustion or fear of movement?

Has the person begun to avoid activities that they previously performed without fear?

How pain affects work, relationships, sleep, recreation, and the ability to care for oneself.

What medications are used and how often painkillers are taken.

What can help

The first step is a medical assessment and identification of possible mechanisms and causes of pain. The presence of emotional stress should not automatically stop the search for somatic causes.

For chronic pain, treatment often requires an integrated approach. Depending on the condition, it may include drug therapy, physical rehabilitation, gradual restoration of activity, sleep work and psychotherapy.

Psychotherapy for chronic pain is not aimed at proving that the pain is “psychological.” It may help reduce fear of pain, catastrophizing, activity avoidance, chronic stress, and the impact of symptoms on life.

Psychotherapy also works with other questions: not only “Why do I have pain?”, but also “How has pain changed my life and what will help me gradually regain more activity, autonomy and quality of life?”

For daily self-support for chronic or recurring pain, you can use the PainFlow app, developed with the clinical support of our specialists. It helps you monitor pain levels, mood, and energy, notice changes in condition, plan activities based on available strength, and use short practices in breathing, grounding, body awareness, and emotional regulation. The app also includes self-help tools for times of increased pain. PainFlow does not replace a doctor, diagnosis, treatment or psychotherapy, but can be used as an additional support tool in everyday life.

When to ask for help

Contact your doctor if pain persists, recurs, gets worse, or significantly limits your daily activities.

If a medical examination does not reveal a cause that fully explains the intensity or duration of symptoms, this does not mean that the pain is “not present.” A more comprehensive assessment of the mechanisms of chronic pain and the factors that maintain it may be necessary.

If prolonged pain is accompanied by severe anxiety, depressed mood, sleep disturbances, social isolation, or persistent health fears, it may be helpful to additionally consult a mental health professional who has experience with chronic pain and physical symptoms.

Urgent medical attention is needed if the pain comes on suddenly and is of unusual intensity, accompanied by chest pain or pressure, severe shortness of breath, loss of consciousness, sudden weakness or numbness, difficulty speaking, high fever, serious injury, or a rapid deterioration in your general condition.