Psychogenic pain is a disorder that manifests as pain in one or more anatomical areas, is caused by psychological factors, and the patient’s main attention is drawn to this pain, and can lead to severe stress and functional disability. Pain disorders are quite common. Its exact prevalence is unknown, but in the United States, some degree of work incapacity due to psychogenic back pain alone is estimated at 10-15% of the adult population each year. Symptoms, signs, and diagnosis: Pain related to psychological factors is common in many psychiatric disorders, especially affective and anxiety disorders, but in pain disorders, pain is the main complaint. Any part of the body may be affected, with the back, head, abdomen and chest probably being the most common. Pain may be acute or chronic (more than 6 months). The patient may have a physical condition that explains the pain but does not cause pain of the severity, duration, or degree of dysfunction that the patient is currently experiencing. If such a disorder does exist, the pain disorder should be due to a combination of psychological and somatic factors, and if such a disorder does not exist, the pain disorder should be diagnosed as psychological. The diagnosis generally requires the exclusion of physical disorders that may explain the patient’s pain. Understanding the patient’s psychosocial stressors may explain the cause of the disorder. As with conversion symptoms (see Section 185, Somatic Symptoms Reflecting Psychological States), the clinical diagnosis is facilitated if the symbolic meaning of the symptoms is identified. For example, the patient describes the back pain as a back stab or an overwhelming burden. Treatment: A thorough physical examination followed by a firm reassurance by a trusted physician is usually effective for the patient. Sometimes a sympathetic approach to the relationship between psychosocial factors and pain can also be effective. Of course, many patients develop a chronic course and have poor outcomes. They are similar to patients with conversion disorder (see above) in that they are reluctant to recognize the relationship between their problem and psychosocial stress and thus refuse any psychotherapy. They seek a dependent doctor-patient relationship, where the problem persists for a long time and thus requires constant help from the doctor. They go to many doctors for treatment and ask for somatic treatment for their non-somatic illnesses. A complete examination by a caring physician who is alert to the patient’s possible new physical illness while protecting the patient from unnecessary, costly or dangerous tests may be the most beneficial in the long term.