Objective: Medically unexplained pain is a common manifestation of psychological distress in children, though establishing this diagnosis is seldom an easy task. This study aimed to enhance and share clinical insights in the complex interplay of medical and/ or psychological factors in these children as revealed by multidimensional assessment, to help in their effective management. Methods: Researchers assessed 65 consecutive children with unexplained pain for more than a month, referred by pediatrician. Of these, 59 consented and completed the interview. Clinical interview by psychiatrist generated psychiatric diagnosis as per ICD – 10 research criteria. Global functioning of the child (CGAS) and relational functioning of the family (GARF) were assessed before and after treatment. Psychosocial stresses were assessed clinically and treatments given to child and/or parent were recorded. Psychologist assessed intelligence of the child using Raven’s Coloured Progressive Matrices and administered Children’s Apperception Test (CAT). Results: A total of 38 (64.4%) children fulfilled criteria for Persistent Somatoform Pain Disorder. Most of them (89.8 %) were undergoing personal, familial and social stresses, many of which were revealed only after detailed clinical assessment. Major depression (28.8%), intellectual subnormality (11.9%), non-organic enuresis (8.5%) and ADHD (8.5%) were common co-morbid psychiatric diagnoses. Children with varying intellectual levels were proportionately represented, and colored the clinical complexity. Repression and reaction formation were common defenses and fear of loss of love of parent, injury, being overpowered were common fears as revealed on CAT. Conclusion: Unexplained pain was often a somatic expression of emotional needs in these children. Psychosocial adversities were common and often causative. However being subtle, these were routinely unidentified. Precise assessment is the key to effective management of these cases.