Understanding the real source of your chronic pain
A guide to understand the difference between structural pain and psychosomatic pain; Suzanne Ferreira (Physiotherapist (BPhysT)); 5-min read with a self-assessment and simple tools for reflection.
28 million adults experience chronic pain in the UK (Fayaz, 2016). That is enough people to fill the iconic Wembley Stadium over 300 times.
Pain isn’t always rooted in a structural problem – in other words, you can experience pain in the absence of a muscle rupture or a broken bone. This very real pain is called psychosomatic pain. This article will help you distinguish between structural and psychosomatic pain. It’s designed to guide you toward more informed, mind-body decisions — whether you’re considering surgery or exploring alternative treatment options.
What is psychosomatic pain?
Psychosomatic pain is pain signals amplified by your brain and nervous system.
Visualise it like this: if you bump your toe on a shelf corner, your nervous system sends pain signals to your brain, and your brain decides that the shelf doesn’t pose life-threatening danger. After the pain subsides, your brain focuses its energy on more important matters.
However, chronic pain, like migraines, continuously sends pain signals to your brain. Your brain engages with this pain continuously, and the neural pathways to this pain become sensitive.
Additionally, your brain manages your emotions, beliefs and expectations too. So, very soon, chronic pain signals are associated with emotions, beliefs and expectations.
Take Mr. N for example. Mr. N is a 40-year-old policeman, and despite having no structural causes showing up on his MRI scan, he has reported episodes of back pain for the past year. After a thorough investigation, Mr. N realised that the stress he experienced due to his perceived thought that he is a ‘burden on his colleagues’ amplified his experience of back pain after a long day’s work (Syahnaz, 2010). (Schubiner, 2017)
| Facts about Psychosomatic Pain | Common Psychosomatic Pain Presentations |
|---|---|
| It is a mind-body connection – for example, blushing | Lower back pain |
| It is universal | Neck and shoulder tension |
| It is neither an indication of incompetence nor malingering | Chronic fatigue |
| It shows us how we are constructed as humans | Headaches and migraines |
| It is an opportunity for greater self- awareness and self-care | Fibromyalgia |
When Surgery Isn’t the Answer to Psychosomatic Pain
Surgery is a yes for structural damage. But what if your scans and clinical tests show no clear damage despite your pain? If you have psychosomatic, rather than structural pain, surgery has certain risks. See the infographic below to compare:
![surgery or psychosomatic pain article[36] 1](https://sfstudioslondon.com/wp-content/uploads/2025/07/surgery-or-psychosomatic-pain-article36-1-1024x327.png)
Adapted from (Carragee, 2006) and (Louw, 2016)
Self-Check: Reflect on the following questions:
Self-assessments are not diagnostic
- Do I feel like my pain increases when I experience anxiety, fatigue or stress?
- Does the location of my pain change, for example, moving from my knee to my hip to my back?
- In the greater context of my life, have I experienced trauma, chronic stress or burnout?
- Has my pain been present, but undiagnosed, during the past 3 months?
If you have answered yes to the questions above, you may be experiencing psychosomatic pain.
Pain is complex, and deeply personal. It is often entangled with stories and life experiences that go beyond muscles and joints.
Recognising psychosomatic influences is not about doubting the pain, it’s about understanding the person in pain more completely
So, what do I do from here?
A mind-body approach to pain is a comprehensive and medically approved way to approach your pain.
- Book a session with a physiotherapist trained in psychosomatic pain and ask for a holistic assessment, which will include your stress, emotions and lifestyle factors.
- Talk. Find a person who gives you the space to talk and be listened to.
- See your pain as an opportunity to understand yourself and your mind-body connection better.
- Always continue with the basics – no, the solid foundation – of gentle movement, breath work, healthy eating, hydration and quality sleep.
Final Thoughts
Chronic pain doesn’t always mean you’re broken – sometimes, it means your nervous system is on high alert. By exploring both physical and emotional contributors to pain, you’re not only empowering your recovery but also opening the door to deeper self-understanding. Whether your next step is a conversation, a physio session, or simply taking a breath, you’ve already begun the healing journey.
Bibliography
Carragee, E. J. (2006). Are first-time episodes of serious low back pain associated with new MRI findings? Spine, 31(24), 2817–2823. doi:https://doi.org/10.1016/j.spinee.2006.03.005
Fayaz, A. C. (2016). Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. doi:https://doi.org/10.1136/bmjopen-2015-010364
Louw, A. D. (2016). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 1720–1731. doi:https://doi.org/10.1016/j.apmr.2011.07.198
Schubiner, D. H. (217, Aug 27). Mind Body Syndrome Lecture Part 1. Retrieved June 2025, from https://www.youtube.com/watch?v=R-mP2wqafnI&ab_channel=MikeBlumenthal
Syahnaz, M. H. (2010). What lies beyond the pain? A case report. Mental health in family medicine, 7(4), 233–237. doi:PMCID: PMC3083251
