Healing vs hurting words: the power of language in pain perception – a narrative review

Key Points

1. Language shapes pain perception in clinical practice.

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BACKGROUND & OBJECTIVE

We continue to make progress in understanding the complexity of pain and the pain experience. The Association of the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (1). Pain is more than the nociceptive apparatus and the central nervous system. There is certainly bottom-up influence on the pain experience and there is top-down influence from cognitive, emotional, and contextual signals. The neural networks that modulate pain are continuously shaped by the experience of being in pain (2).

The authors of this narrative review explored the evidence on the role of language in modulating a pain response and the perception of pain. They focused on three points:

1. A cognitive stimulus shaping expectations and attention.
2. A neural modulator influencing pain-related networks through top-down mechanisms.
3. A therapeutic tool for clinical interventions.

The neural networks that modulate pain are continuously shaped by the experience of being in pain.

Language that increases fear of movement or reduces belief in recovery can worsen outcomes and discourage people from accessing therapy.

METHODS

• This study was a narrative review of the literature from 2016 through March 2026 of pain neuroscience, communication research, placebo/nocebo mechanisms, and rehabilitation approaches.

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