somatoform?

i brought up the question of somatoform to my psychologist because of chronic rotator cuff, hip joint, and back pain that as of yet has not been fully explained. he wants me to rule out all physical testing options first.  i only show mild to moderate carpal tunnel in my wrists-i had a nerve test done by my neurologist. i get an mri on my back thursday but i doubt much shows up, my back pain is mainly muscle pain. i'm pretty sure there is no structural damage to my spine because i don't have constant pain. i've had x-rays that show some arthritis in my hips along with some advanced wear in my hips and rotator cuffs but the doctor didn't seem to think it should cause as much pain as i have. i have noticed lately that stress makes the pain worse but that isn't always the case. activity makes all of it worse. isn't somatoform pretty rare? i have most of the symptoms but i just hate thinking it's all in my head because my pain is very real and debilitating. any suggestions for me to ask my regular doctors or my psychologist?  i'm tired of the pain med and muscle relaxers (which i don't take everyday-almost but not quite) that my family doc prescribes. the meds just dull the pain and muscle spasms, i want a cure, if i have somatoform what is the cure or treatment options? thanks velvetvenus

[J T Junig, MD PhD]

Somatiform disorder is a broad category that includes pain disorder, somatization disorder, conversion disorder, body dysmorphic dysorder, and somatiform NOS--  I was not 'struck' with the idea of a somatiform disorder when you described your symptoms.  With the somatiform disorders (with the exception of pain disorder, which can be partially caused by 'real' injury) the pain is not explained by actual physical injury, but rather is caused by the mind.  To the patient, the symptoms are as real as in 'true' injury;  if the patient can tell that they are not real, then it is not a somatiform disorder, by definition!

But... you describe a couple of sources for your pain, which makes me think that you are not dealing with a somatiform disorder.  The only thing that would fit at all is 'pain disorder with psychological symptoms'--   to have somatization you would need more non-muscular symptoms (headaches, sexual dysfunction, chest pain, bowel problems, etc) and for conversion disorder you would need nervous symptoms like paralysis or blindness.  Treatment for all of the somatiform disorders primarily consists of slow, patient psychotherapy.

I am in agreement with the doc who suggested ruling out the muscular injuries first.