The Term "Chronic" Pain and Its Effect on Pain Perception, Acceptance, and Management Outcomes
Introduction
We are all aware of the close relationship between mind and body.
Pain remains one of the most widespread medical problems — yet it carries profound psychological consequences that are often overlooked. Healthcare providers working in multidisciplinary teams recognize the difficulties of treating pain despite the full range of available interventions. Patients recognize it too. What receives less attention are the hidden factors — the invisible components that may be influencing pain management in ways we have not yet fully examined.
Diagnosing and classifying pain is critically important. The type of diagnosis affects not only how patients cognitively and emotionally process their condition, but also how they respond to treatment. In this sense, the probable negative impact of a diagnosis can function like the side effect of a medication — shaping pain experience and interfering with management outcomes before treatment even begins.
From a psychological perspective, I have spent many years asking a deceptively simple question: Is the word "chronic" itself part of the problem?
Is it necessary to use the term "chronic" as a diagnosis in medical practice? Is it appropriate to inform a pain patient this way?
I believe the term "chronic" may be one of the hidden factors worsening pain management outcomes — placing patients in cycles of endless suffering, and functioning as a kind of stigma not unlike a dangerous disease. How we communicate with pain patients is an integral part of pain management. We need to reconsider how we diagnose — because pain management begins at the moment of diagnosis. Diagnosis is part of treatment.
Before deciding how to diagnose and treat pain patients, we must first ask:
How do we inform them about the nature of their pain?
How do we explain and interpret their complaint?
How do we choose words that influence cognition and emotion gently and positively — enabling them to accept their pain and improve their perception of it?
How do we maintain safe communication with pain patients?
How do we explain the treatment plan?
All of these shape pain perception and acceptance, and ultimately determine whether management strategies succeed or fail.
The probable negative psychological effects of using the word "chronic" deserve investigation across all medical and psychological practice.
The Weight of the Word "Chronic"
When we describe pain as "chronic," we increase, confirm, complicate, and amplify the problem. Pain becomes a well-established chronic issue in the patient's mind — and may stand as a barrier against every effort to resolve it.
Critical medical language affects not only patients, but those around them. Recent research in patient-centered care and patient experience has called for more thoughtful communication — including proposals to replace the word "patient" with "the person served." Yet medical textbooks remain full of alarming terms that have never been reviewed for their psychological impact on the people who receive them.
Terms like brain death, brain damage, stroke, renal failure, respiratory depression, cancer, paraplegia, quadriplegia, chronic psychotic disorders — these carry terrifying meanings for people unfamiliar with clinical environments, and can cause additional suffering in translation, whether linguistic or emotional.
One article on chronic pain argued that both patients and providers should simply accept the chronicity of chronic pain. McAllister (2015) wrote: "Why does the healthcare system refuse to accept the chronicity of chronic pain? Most healthcare providers take care to discuss with their patients that there are no cures for these conditions."
But consider what this means in practice. Telling a patient they have chronic pain — and that there is no cure — increases suffering, increases medication intake, risks addiction, and prolongs the treatment journey. The chronicity of pain may actually be established through communication that begins on the provider's side.
McAllister also noted that accepting the chronicity of chronic pain may be harder than accepting other chronic conditions — like diabetes or hypertension. This suggests we must be more careful about how we communicate a pain diagnosis, choosing words that do not generate negative reactions in the patient's mind and body.
Healthcare providers should instead focus on reducing the duration of treatment — offering support and reassurance, using organized and gentle communication that facilitates improvement, rather than convincing patients to accept that their pain will never resolve.
The complexity of chronic pain may in fact be hiding behind the term "chronic" itself. Nobody thinks to study the effect of the word on patient reactions.
I would prefer to tell patients they simply have pain — not "chronic," not constant, not lasting pain. I suggest dropping the word "chronic" from pain classifications. This is the central argument of this article.
If we inform patients precisely about their condition as it is, we may inadvertently increase their anxiety and worry — negatively affecting pain perception, acceptance, and the treatment plan. If a patient reads a pain information leaflet and its list of side effects (3), they may refuse medication entirely, believing they will experience everything listed.
The word "chronic" interacts with the patient's mental functioning, body, and emotional state — touching every element of their life. It generates negative expectations across psychosocial dimensions: mood, cognition, behavior, work, study, and family responsibility.
Through the mechanisms of mind-body interaction, "chronic" shapes pain perception in ways that can reduce pain tolerance, worsen pain experience, and ultimately compromise treatment outcomes and quality of life.
Stopping the use of "chronic" may lead to more normal and positive pain perception — improving acceptance, increasing tolerance, and enabling more effective management.
When a patient is told they have chronic pain, they may be shocked. They may deny the diagnosis. They may become consumed by the label — unable to challenge it, trusting the doctor's authority completely. Most patients are hoping for good news. Most want to hear something reassuring.
"Chronic" may instead trigger anxiety and depression, generating negative thinking about work, study, relationships, and family life. And once a patient fully accepts that they have real chronic pain, we lose the ability to predict or control their hidden psychological and physiological responses — in the nervous system, the immune system, the endocrine system. (4)
The Power of Words on Patient Perception
"Words can inspire, and words can destroy. Choose yours well." — Robin Sharma
"Every word you speak has the power to hurt or to heal." — Posivibe Man
"Be careful with your words. Once they are said, they can be forgiven — but not forgotten."
Three Cases
Case 1
Many years ago, I heard of a cancer patient being treated at a hospital in the United States. He recovered from his disease — a remarkable outcome that puzzled his doctors, who asked him whether he had sought treatment elsewhere.
He said no. They told him his results had been dramatic. He replied: "I heard you — I have a hearing problem — say during your medical rounds that my case was curable."
This led him to believe, through a cognitive process, that he would recover. That belief positively influenced his perception, supported his acceptance of his condition, and ultimately improved his treatment outcomes. In reality, his case had been complex and considered hopeless.
The doctors realized that his recovery may have been shaped by a single word: curable rather than incurable. That word affected his perception, his nervous system, his emotional state — and possibly his immune response. It may have been the power of mind-body interaction that healed him.
We should pause and imagine what would have happened if this patient had heard the accurate word: incurable. It could have been an entirely different story.
Case 2
A man diagnosed with terminal metastatic cancer — reported by Dr. B. Klopfer in the Journal of Projective Techniques in 1957 — had tried every available treatment. His condition had deteriorated to the point where he was bedridden and gasping for air. His doctors gave him only days to live.
The man heard of an experimental drug called Krebiozen being tested at the time. He insisted on being included in the trials. His doctors, believing he had nothing to lose, agreed — and his tumors began shrinking dramatically. He was discharged from hospital.
Two months later, he read reports casting serious doubt on Krebiozen's effectiveness. Within days, his tumors returned.
His doctor, cleverly, told him a new and more potent shipment had arrived — and injected him with plain water. His tumors began shrinking again. He remained healthy for seven more months, until a national announcement declared the drug completely worthless as a cancer treatment.
He died within two days.
Case 3
A 19-year-old male underwent an above-knee amputation due to cancer. During daily wound dressing, he refused to have it done on the ward — shouting, fearful, crying — insisting on being taken to the operating room (OR). After two days of this behavior, the ward nurse referred him to me for psychological consultation.
During the interview, he explained that someone had told him the dressing in the OR was better than on the ward. He believed the OR provided better pain medication. This was entirely a matter of perception — the medication was identical in both locations.
After establishing rapport and providing support, I promised to bring the same medication from the OR to the ward. I addressed his perception directly. He agreed, received the dressing calmly on the ward, and made no further complaints.
Patient Rights
This article is not a call to withhold accurate diagnosis from patients — they have the right to know their medical status. But that right should be exercised thoughtfully, not in ways that are harmful or unnecessarily alarming.
Some patients cannot tolerate or fully understand the nature of their condition. Some carry psychological vulnerabilities in their history. Some are not ready to receive a serious diagnosis without preparation.
I am not calling for changes to treatment protocols or clinical systems. The management plan should remain the same. My concern is with how patients are informed — how their complaints are interpreted, and how their diagnosis is framed.
Healthcare providers can use simple, safe, and appropriate language — avoiding the term "chronic" — because simple and safe words may carry a positive component, or at minimum produce a neutral response. They can function like suggestion — similar to the placebo effect — producing positive physiological responses and facilitating the treatment process.
Simple, safe language helps patients feel calm, relaxed, and satisfied. It supports acceptance, promotes positive pain perception, and allows treatment to progress without the burden of worry or harmful expectations. This is ultimately what we are working toward.
Pain is considered one of the five vital signs — which means it demands careful, considered communication, especially in patients with hypertension or diabetes.
Therapist Behavior
Some physicians use critical medical terms frequently and casually in front of patients, without considering what those terms mean from the patient's perspective. How will the patient understand it? How will they cope with it? How will it affect their mind and body?
Physicians sometimes use alarming clinical language in front of family members and visitors too. They have become habituated to these terms — they are normal vocabulary within the clinical world. From the patient's perspective, the experience is entirely different.
Caution in Diagnosis
Pain patients need support, encouragement, reassurance, and comprehensive psychological and social care to face their pain and their treatment journey. In managing pain, we should exercise caution when delivering a diagnosis, for the following reasons:
Most people already have some knowledge about chronic pain and its treatment difficulties — from media, relatives, or friends.
Are we obliged to tell a pain patient they have chronic pain? Serious and critical labels can increase tension and anxiety, interfering with the management plan.
Some pain patients have additional or multiple medical issues.
Some people strongly dislike being labeled as a "patient" and hold negative expectations about illness and medication.
Some people avoid hospitals and clinics due to high sensitivity to medical environments — which can itself generate tension, anxiety, and frustration.
Some people experience fear and anxiety in response to medical stimuli — blood, injured people, ambulance sirens, clinical smells.
Some patients carry negative experiences from previous medical encounters and fear critical diagnoses.
A patient may have underlying psychological problems, predisposing factors, or trigger points that interact with a difficult diagnosis.
Depressive, obsessive, and anxious personality traits exist to varying degrees in most people and may worsen pain — and are difficult to identify without thorough evaluation.
Every patient has a different pain threshold and tolerance level.
Every patient understands and reacts to "chronic" differently — shaped by culture, religion, beliefs, values, and prior experience.
The patient may perceive "chronic" as dangerous — placing them in a state of alarm that affects their thinking and behavior, and indirectly activates their endocrine, nervous, and immune systems.
"Chronic" indirectly reinforces pain suffering and unconsciously generates frustration, potentially complicating or worsening the pain problem.
The patient's psychological response to "chronic" may resemble the response to a hopeless prognosis — or to a diagnosis of cancer.
Goals and Objectives
If we avoid using the term "chronic," we may achieve the following:
Reduce negative psychological complications — tension, anxiety, depression — that interfere with healing.
Reduce medication intake, including painkillers and narcotics, avoiding side effects, addiction, peptic ulcer, and renal failure.
Avoid unnecessary surgical interventions requested by patients seeking any available alternative.
Reduce the financial costs of pain treatment — fewer and shorter hospitalizations, fewer repeat admissions and follow-up visits.
Improve outcomes during the treatment process.
Strengthen the therapeutic relationship between patients and care teams.
Support and reassure patients toward meaningful improvement.
Offer patients a normal and peaceful life, free from stigma.
Advocate for reconsidering or removing "chronic" from general pain classifications, medical references, and medical education.
Encourage researchers to examine the effects of similarly critical terms across other specializations — hypertension, diabetes, neurology, oncology, cardiology.
Involve psychiatrists and clinical psychologists when pain management teams communicate a diagnosis to patients.
Conclusion
Given the close relationship between mind and body, certain critical diagnostic terms carry negative psychological effects on patients — effects that can interfere with treatment plans, particularly in pain management.
The term "chronic" is one such term. It needs to be studied empirically to fully understand its effect on pain management outcomes.
Published in MAR Neurology, Neurosurgery & Psychology (2023) 7:2