Psychogenic pain

Pain is a symptom commonly encountered by the medical profession. After excluding organicity, the possibility of psychogenic mechanisms should be borne in mind. Diagnostic clues in the history and physical examination are outlined. An early referral to the psychiatric services minimises wastage of time and resources but requires skillful handling and sensitivity on the part of the referrer. Patients do not regard themselves as psychologically abnormal and are often resentful and angry when referred for psychiatric evaluation. Principles of management are described with emphasis on establishing an early rapport. Cognitive behavioural methods appear promising but require further evaluation in controlled studies.