What causes psychosomatic pain and what types of treatment can help manage it?

It is important to define what is meant by psychosomatic pain. In fact, this may refer to a psychiatric disorder, in particular a somatic symptom disorder (according to the Diagnostic and Statistical Manual of Mental Disorders-5), which is characterised by one (or more) physical symptoms that cause distress or have a major impact on people’s daily lives. This physical symptom is accompanied by a high level of distress, or excessive behaviour in response to this physical symptom. It is not known precisely how many people live with this condition, but it is thought to affect less than 5% of the population. Somatic disorders are often caused by a number of factors. It may, for example, be the physical expression of extreme psychological distress as a defence mechanism. Or it may be the result of attributing the cause of symptoms to physical rather than psychological origins.

But the term somatic is used in a number of more or less precise ways, which can lead to a great deal of confusion. More often than not, when we refer to psychosomatic pain, it is often because we are unable to identify a precise cause for the chronic pain. However, the mere fact that doctors cannot identify a precise cause to explain a pain is not sufficient or necessary to say that this pain is somatic. Rather, somatic pain is diagnosed when there are physical symptoms that are associated with abnormal thoughts, feelings or behaviours related to these symptoms.

In the majority of cases, people living with chronic pain do not have a disorder with somatic symptoms. That said, psychological factors very often play a role in the experience of pain. In this sense, it is crucial to understand the experience of chronic pain holistically, from a bio-psycho-social perspective. This point of view recognises that the experience of pain is influenced by biological, psychological and socio-cultural aspects. Let’s take a simple example to illustrate this: stubbing your little toe on the corner of the bed. If I stub my toe while arguing with my partner, the pain in my toe will be much more intense than if I stub my toe when someone calls to tell me I’ve just got a new job. Yet it’s the same stub I’m getting! The brain uses not only the information linked to the blow, but also the context, memory, emotions, etc. to interpret this information and generate the perception of pain. I suggest you watch these videos to gain a better understanding of chronic pain (https://www.youtube.com/watch?v=I7wfDenj6CQ; https://www.youtube.com/watch?v=IcdsYdUls44). We are increasingly aware that the brain plays a central role in the experience of pain.

As you can see, pain management involves multiple approaches, including pharmacological treatments such as medication, physical approaches such as physiotherapy and exercise, and psychological approaches. A number of self-management programmes for pain have been set up, including this one: https://gerermadouleur.ca/agir-pour-moi/. And a wide range of resources for managing pain can be found here: https://gerermadouleur.ca/en/.