​The majority of people who have not visited a physiotherapist may not be aware of the term "psychosomatic pain", a physical pain that is caused by emotional, psychological, or mental factors, rather than direct physical injury or illness alone. 
Although it is often under-recognised and misunderstood, it is estimated that up to 20 - 30% of patients in physiotherapy settings may present with pain that has a significant psychological or emotional component, even if it initially appears to be purely physical. 
According to Palesa Phetwane, Physiotherapist at the West Rand District Health Services, stress is one of the major causes of psychosomatic pain. Stress causes many bodily functions to deteriorate or not work properly without people noticing it. 
"Along with stress, which is described as a form of psychological and mental discomfort, anxiety, depression and unresolved trauma or abuse can lead to psychosomatic pain. 
"Anxiety leads to muscle tightness, especially in the neck, shoulders, jaw, and back. Depression alters brain chemistry and pain processing. People with depression may experience generalised body aches, slowed recovery, or reduced pain tolerance. In other cases, Unresolved or Past trauma, especially in childhood (emotional, physical, or sexual), can manifest as chronic physical symptoms in adulthood," said Phetwane.
Common symptoms of psychosomatic pain include headaches, back pain, abdominal discomfort, fatigue and generalised aches. It is diagnosed through a process of exclusion and careful clinical assessment, especially when no visible injury or medical explanation is found. Tests may include blood work, imaging (X-rays, MRIs), and neurological exams. 
However, conditions like Somatic Symptom Disorder (recognised in DSM-5) are assessed by a trained professional and considered when pain persists despite normal test results. The person shows excessive worry or behaviours related to the symptoms. 
Itumeleng Matlala, Physiotherapist at Rahima Moosa Mother and Child Hospital said that common misconceptions that patients have about psychosomatic pain include phrases such as "there's no injury, the pain must be fake" or "Talking about emotions won't help my pain". 
"To ensure that we help patients accept that their pain might have a psychological component without making them feel dismissed or misunderstood, we firstly validate the pain as real and educate patients using gentle, non-stigmatising language," said Matlala.
Treatment and management of psychosomatic pain include aerobic exercises as they boost endorphins, reduce anxiety, and improve mood; balance training which restores confidence and physical stability or coordination; manual therapy and stretching; and relaxation therapy which reduces stress and enhances emotional regulation. 
Physiotherapists also use treatments that include patient education on how stress affects posture, breathing, and muscle tension, as well as strategies on how to manage pain by tailoring exercises to each patient's individual needs and pain symptoms.
In addition, to ensure that patients are able to manage psychosomatic pain at home, there are tailored exercises to each individual's needs. This includes incorporating deep breathing exercises and core stability exercises, as well as encouraging gentle movement like walking, yoga, or stretching amongst others.