Why managing expectations matters in chronic pain treatment

In a 2026 study I conducted with colleagues on people with peripheral arterial disease, one participant described how leg pain had disrupted his golf for years. It forced him to stop mid-round, shake his leg and apologise to his playing partners while he waited for the pain to pass. He found it mortifying. Then he tried a small electrical device that delivered gentle pulses through pads stuck to his skin. He still had pain. But he could get round the course.

When we measured his walking on a treadmill, we found no improvement. He had not noticed. That was not the outcome that mattered to him. Before the study ended, he had already gone out and ordered his own device.

A different participant reached the opposite conclusion. The pain was still there when he used the device, he said. It had not done him any good. And he was right, in a narrow sense. The device had not eliminated his pain. What it had done was reduce its intensity and delay its onset, allowing him to walk measurably further. His expectation of complete relief meant that genuine, partial relief felt like failure. He concluded the treatment did not work.

The study did not tell a simple story of success or failure. For some participants, standard treadmill measures did not capture what had changed in daily life. For others, measurable improvements still failed to feel meaningful because they fell short of what the person had hoped for. The difference was not only the treatment, or the severity of their condition. It was what each person had been led to expect.

Recognising relief

Both men were living with peripheral arterial disease, a condition caused by a build-up of fatty deposits inside the arteries that supply the legs. It affects an estimated 236 million people worldwide. Its hallmark symptom is a cramping pain in the calf during walking that eases with rest. Over time, it can shrink a person’s world, limiting independence and increasing the risk of serious cardiovascular problems.

The recommended first-line treatment is supervised exercise therapy: structured exercise sessions led by trained professionals. But in many countries, access to supervised exercise therapy remains patchy and under-resourced. That gap is fertile territory for the wellness market.

Transcutaneous electrical nerve stimulation, or Tens, delivers small electrical impulses through electrode pads on the skin to interfere with pain signals travelling to the brain. There is evidence that it can help with some kinds of pain, and it is used in hospital pain management settings. It is not a wellness product. In our study, we explored what happened when people with peripheral arterial disease used TENS independently at home, outside the controlled conditions of a clinical trial.

The findings point to something standard clinical tests rarely capture. Expectation can shape whether useful relief is recognised as useful.

That finding matters well beyond this particular device or condition. The global wellness industry is worth over a trillion dollars and operates with minimal regulatory oversight. People living with painful long-term conditions are among its most heavily targeted consumers. Companies sell electrical stimulation devices, supplements and wearable gadgets to people in chronic pain, using influencer testimonials in place of evidence and social media algorithms to reach people who are frightened, frustrated or in pain.

When a product fails to deliver the transformation it promised, patients rarely conclude they were misled. They conclude that nothing can help them. In conditions where reduced physical activity carries real health consequences, that conclusion is not merely disappointing. It is dangerous.

Poor communication can hinder treatment results

This is where the study speaks to a much wider problem. Whether a person is using a clinical device, a wearable gadget or a supplement sold online, they are often asked to judge it against expectations they did not set for themselves. Even legitimate, clinically tested treatments can be undermined by poor communication about what to expect.

The golfer’s experience illustrates this clearly. He valued an outcome that no clinical trial had thought to measure: the ability to play a round of golf without humiliation. Once he understood the device could offer that, it worked for him. His fellow participant was never given the chance to find his equivalent.

A market built around selling hope is poorly equipped for that kind of honesty. But the same danger can appear even when the person giving advice has medical credentials. Research shows that even medically qualified doctors who become prominent wellness influencers on social media are subject to many of the same pressures as their unqualified counterparts: to build a personal brand, produce content constantly, stand out from competitors and make advice sound more certain than it really is. Having a medical degree does not make someone’s Instagram post better at managing a patient’s expectations. It just makes it more convincing.

What actually helps requires something platforms cannot provide: time, a genuine clinical relationship and communication that is not contingent on making a sale. It requires asking a patient not just whether their pain has reduced, but what they were hoping to do that pain had been stopping them from doing. It requires explaining that partial relief is still relief and that the outcome worth measuring might not be the one on the form.

That kind of honesty does not feature in any influencer’s discount code, medical degree or otherwise. But for the person who just wants to get round the golf course, it might be the most important part of the treatment.