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

Pain is increasingly understood as a multidimensional and inferential experience shaped not only by nociceptive input but also by cognitive, emotional, and contextual factors. Among these modulators, language appears to play a central role in shaping pain perception through semantic framing, verbal suggestion, expectation, and interpersonal communication. This narrative review aimed to synthesise contemporary evidence on the relationship between language and pain perception, with particular focus on musculoskeletal rehabilitation and Pain Neuroscience Education (PNE). A structured literature search was conducted in PubMed and Scopus for English-language studies published between 2016 and 2026. Experimental studies, randomized controlled trials, neuroimaging investigations, and clinically oriented rehabilitation studies examining linguistic influences on pain perception were considered eligible. Sixteen studies met inclusion criteria and were narratively synthesised. Three interconnected domains emerged from the evidence. First, pain was consistently conceptualised as an inferential and expectation-shaped experience, in which attention, prior beliefs, and predictive processes modulate sensory interpretation. Second, verbal suggestion and semantic framing were shown to influence pain-related neural and behavioural responses. Pain-related words, threatening descriptors, and negative expectations were associated with increased pain perception and altered activity within salience and pain-regulatory networks, whereas positive framing and empathic communication appeared to facilitate adaptive modulation and placebo-related responses. Third, PNE and language-based rehabilitation approaches demonstrated potential to reduce fear, catastrophising, and maladaptive threat appraisal, particularly when integrated within multimodal rehabilitation programs including exercise, motivational interviewing, and psychologically informed physiotherapy. Overall, the evidence suggests that language is not merely descriptive but functions as an active contextual and neurocognitive component of pain experience. Clinically, communication may influence therapeutic alliance, behavioural engagement, and pain-related beliefs, with both therapeutic and ethical implications. However, current evidence remains limited by methodological heterogeneity, short-term experimental paradigms, and limited ecological validity. Language-based interventions should therefore be considered facilitators within broader biopsychosocial rehabilitation strategies rather than stand-alone treatments. Future longitudinal and clinically pragmatic studies are needed to clarify the durability, mechanisms, and translational applicability of linguistic modulation in pain rehabilitation.