Persistent Somatoform Pain Disorder

Some people suffer from vague physical complaints and have to keep hearing from doctors that they “have nothing”, although they suffer from various complaints. Most often it is a persistent somatoform pain disorder (ASD) . Another synonym for the disease is psychalgia .

What is Persistent Somatoform Pain Disorder?

According to whicheverhealth, the persistent somatoform pain disorder is not caused by physical disorders, but by an increased pain and stress perception of those affected towards other people.

A persistent somatoform pain disorder is a symptom in which those affected suffer from persistent pain for months for which there is no organic cause.

Mostly there is a close connection with psychological stressful situations. At least as a trigger, they play a role in the severity and duration. Subjectively, the pain can be felt very strongly without those affected simulating it.

It determines the whole of life and can severely impair work, social contacts, etc. In the long run, the persistent somatoform pain disorder can lead to depression and increased suicidal tendencies.


The persistent somatoform pain disorder is not caused by physical disorders, but by an increased pain and stress perception of those affected towards other people.

Psychological factors play a major role because the pain sensation is located in the same area of ​​the brain as the feelings. In this way, there is a coupling of pain perception with negative feelings such as deficiency, loss and exclusion. Many factors can play a role, such as: B. Problems in the family of origin, real pain experiences, chronic illnesses, alcohol addiction, separation / divorce, physical violence or emotional deficiency experiences.

Because social and physical sensations are linked on the neurobiological level, pain sensations are triggered at the same time as negative feelings.

Symptoms, ailments & signs

There are no key symptoms in the physical sense for the persistent, somatoform pain disorder. The most important characteristics are the physical complaints themselves and their duration. The pain persists for a period of at least six months. He is experienced as chronic and strong. Body region and expression can change frequently without there being a regular pattern.

Medical examinations do not provide a sufficient physical explanation for the pain experienced. Most often it occurs in connection with emotional conflicts or psychosocial problems. There is a great variety in the exact symptoms, because the disorder can occur in all organ systems. The impairments in the cardiovascular system, gastrointestinal tract, urogenital tract, breathing, muscles and joints are particularly common .

If the cardiovascular system is affected, most patients complain of chest pain , a feeling of pressure in the chest, and palpitations or fluttering. The symptoms in the gastrointestinal tract, on the other hand, can hardly be distinguished from irritable bowel syndrome. Digestive complaints such as diarrhea , constipation , bloating or flatulence are described here.

In the area of ​​the bladder, stinging when urinating, frequent urination, and lower abdominal pain are the most common . Breathing can be affected by shortness of breath and shortness of breath , which can trigger panic attacks. In the case of muscles and joints, back pain or pain in the extremities should be mentioned in particular .

Diagnosis & course

Persistent pain leads to psychological distress, which causes those affected to seek medical help. The doctor first takes a thorough medical history because physical abuse experiences often play a role in the life of those affected. The pain is described more emotionally, less sensory than “burning” or “pulling”.

According to ICD guidelines, the pain must last for a period of 6 months. Mental triggering factors must be differentiated from stressful factors that only occurred in the course of the persistent somatoform pain disorder. No pain progressions in the context of schizophrenia or depression may be taken into account, and also no hypochodric signs.

Everyone knows pain. Most of the time they go away on their own. In those affected by the persistent somatoform pain disorder, they can occur at a young age, but also later. For those who seek psychiatric help, the pain usually lasts for years. For those who, despite the pain, do not make ASD their main activity and continue to pursue their work and maintain social contacts, there seems to be a more favorable prognosis than for those who allow themselves to be controlled by the disease.


Appropriate and early therapy has a decisive influence on a prognosis for the somatoform pain disorder. The earlier this disease is recognized as such and countermeasures can be taken, the better the prospects for a pain-free future. This is the only way to prevent the pain disorder from persisting permanently.

If the autonomic dysfunction is accompanied by depression and anxiety disorders , psychotherapeutic treatment is also necessary. Individual discussions or group therapy are conceivable instruments to alleviate the symptoms of this disease and to improve the prognosis. In individual cases, however, the duration of the illness is decisive for the course of therapy and the associated prospects for a symptom-free time.

As a rule, somatoform pain disorder is a chronic disease because it is not recognized as such and goes unnoticed. The existing symptoms and the pain associated with them are mostly seen in connection with physical illnesses. Examinations and unsuccessful therapies often follow. Even if the environment reacts well and recognizes the disease quickly, the road to improvement can be a long one.

When should you go to the doctor?

Anyone who experiences persistent somatoform pain disorder has often had an odyssey through doctor’s offices behind them. Many of those affected do not feel that they are being taken seriously. You therefore avoid further visits to the doctor after a certain point in time. This is wrong, because help should be given to these patients too.

If pain is an expression of emotional distress or traumatic experiences, this is no reason to stigmatize those affected. It does not reduce pain. On the contrary, the therapy should be much more comprehensive and focus on the suffering person. It is also important to recognize that a persistent somatoform pain disorder can also be traced back to one-sided activities and diagnosed skeletal disorders.

The already chronic pain can often be alleviated with months of physiotherapy . If necessary, accompanying psychotherapy or conventional pain treatment can also help. The persistent somatoform pain disorder is treatable. The chronic pain stimulus can, at least in part, be unlearned again. You can counteract it through manual therapy and try to determine the triggering causes. Therefore, those affected should go to the doctor until they receive help and understand.

A persistent somatoform pain disorder can, but does not have to be, a reaction of the body to emotionally stressful situations. In this respect, it is useful if those affected try to relieve the painful body through self-help measures.

Treatment & Therapy

A complex approach is useful for persistent somatoform pain disorder. Special psychosomatic clinics offer those affected the possibility of an inpatient stay and work with different therapeutic approaches.

First of all, the patient learns to distinguish physical and mental factors and thereby classify his symptoms more clearly. In therapy, a personal explanatory model is worked out with the patient, which also takes into account the psychological factors of ASD, so that those affected do not consider themselves “crazy” or “mentally disturbed”.

Behavioral therapeutic methods help the patient to change negative thought patterns, curb avoidance behavior and strengthen personal resources. They are often combined with relaxation techniques such as progressive muscle relaxation according to Jacobsen, autogenic training or biofeedback .

In depth psychological sessions, traumatic experiences in childhood, attachment problems and emotional factors are dealt with.

Body, music or art therapy are also beneficial in the treatment of ASA.

Treatment with painkillers only brings short-term improvement, if at all. If anything, can Antidepressants help to distance itself somewhat from the pain. The main focus is on psychological stabilization.

Outlook & forecast

A psychotherapeutic treatment can improve the prognosis of persistent somatoform pain disorder. Depending on how complex and how persistent the disease is, the therapeutic interventions range from psychoeducation to lengthy therapies.

If the person concerned suffers from another mental illness in addition to the persistent somatoform pain disorder, this is usually also treated in psychotherapy. For example, depression, another mood disorder, or a specific phobia often co-occurs with the somatoform pain disorder.

A doctor or psychotherapist will often not diagnose the persistent somatoform pain disorder until the patient has been suffering from the disease for a long time. One reason for this is the extensive examinations that are necessary for the diagnosis: Before the persistent somatoform pain disorder can be diagnosed, a primary physical cause for the pain must first be ruled out.

Various individual factors influence the prognosis of the persistent somatoform pain disorder. Social stressors can mean that the persistent somatoform pain disorder persists longer, more areas of the body are affected, or the pain perceived is intensified. The same applies to psychological stressors, although emotional stress in particular can have a negative effect on the prognosis.


A sensible form of prevention consists in not letting the pain dominate your whole life and seeking psychological help if no organic cause can be found for physical complaints. A balanced life with social contacts makes a significant contribution to stabilizing mental health.


In the case of persistent somatoform pain disorders, doctors usually assume that these are primarily psychological causes. Nevertheless, organic causes are possible or play a role. Skeletal damage or diseases can ultimately also be the sole cause of the persistent somatoform pain disorder. In many cases, the psychiatization of patients is politically wanted. The approach chosen is a question of paradigm.

In most cases, follow-up care for persistent somatoform pain disorder has both psychological and physical components. The psychological support can include completing a multimodal pain therapy measure with psychological components, behavioral therapy or conversation therapy. The person affected should learn to pay more attention to their physical needs.

Many aftercare measures rely on personal responsibility. In order to relieve the psyche, the workload should be reduced and stress-reducing strategies learned – for example through resilience training. Moderate sport has a very good effect on the physical level in the case of a persistent somatoform pain disorder. Gentle sports such as swimming, walking, cycling, yoga or Asian sports such as tai chi or chi gong should be preferred.

If the somatoform pain disorder persists, longer care can also be provided by the physiotherapist. Instead of being permanently dependent on pain medication or having to retire early, long-term physiotherapeutic treatment would make sense.

You can do that yourself

Deep relaxation can help relieve symptoms of persistent somatoform pain disorder. Autogenic training and progressive muscle relaxation are suitable methods and are particularly effective if the person concerned uses them regularly. People who suffer from persistent somatoform pain disorder can reserve a fixed time during the day to do the relaxation exercise without any time pressure .

Mindfulness has a similar positive effect. The aim of mindfulness exercises or meditations is to consciously perceive and accept sensory stimuli without evaluating them. Relaxation can also occur. Suggestive meditations and (self-) hypnosis can help some sufferers to change negative attitudes and thought patterns.

Relaxation procedures are not recommended in the case of a psychotic disorder and acute manic episode, as they can worsen the psychotic / manic symptoms. They are also contraindicated during a migraine attack.

Since sleep disorders are a common comorbidity of persistent somatoform pain disorder, self-help can focus on this aspect as well. Regular sleep is very important for good sleep hygiene : Going to bed at the same time each day helps the body develop a solid routine. A quiet evening ritual also supports sleep. Quiet activities such as painting or knitting are beneficial immediately before going to bed.

Such measures can complement psychotherapeutic treatment and are usually very useful. Persistent somatoform pain disorder is a recognized disease. Those affected do not have to limit themselves to self-help and small improvements in everyday life, but have the right to appropriate therapy.

Persistent somatoform pain disorder