Mental disorders with pain as a leading symptom are remnat diagnostic categories for physicians and psychotherapist, even if they are educated in pain treatment. Patients with somatoform pain disorder (ICD-10: F45.4) are often diagnosed only after several years and multiple diagnostic procedures, in some cases after iatrogenic impairment. The clinical practical features, diagnostic procedure and differential diagnosis in somatoform pain patients as well as current psychotherapeutic approaches are outlined.