A semiotic conceptualization of pain in the chronic pain syndrome is proposed. It is suggested that among chronic pain patients pain ceases to be an icon or an index and acquires a symbolic structure: this transformation interferes with the usual patient‐physician relationship. The semiotic perspective on the structure of meaning in the chronic pain syndrome underlines the need to include a psychotherapeutic approach in the patient‐physician relationship; specific aspects of the approach to chronic pain as a symbolic communication are discus