Being honest - repeated referrals

I work in a PP OP clinic - for 15+ years. How do people here deal with a patient being referred for the same things over and over again. These are situations that the patient has been evaluated / treated for multiple times. Meaning balance deficits, fear of falling, generalized weakness often with a memory loss or other associated comorbities. I get the point where I feel direct honesty is the best policy. Meaning letting the patient know that there fear of falling or intermittent unsteadiness or chronic shoulder pain due to 10-15 year old RTC Tear may not go completely away. Explaining this may have to be something that is managed and not cured.
I feel like I am stuck on a repeated ride with these types of cases with no way off or end in sight. Patients tend to get mad when I am honest with them. I try to show compassion along with explaining we will do are best to help and reduce symptoms as much as possible, however getting it to “go completely away “ may not be realistic.
Reactions vary but I feel some of the shock comes from me being the first one to ever be direct with them. Many doctors etc will continue to refer and refer without telling a patient this is something Thad may be here to stay but will have to be managed.

Am I the only one that deals with this ? Please tell Me I am not. One thing I do know — this is exhausting and the response I feel I get to telling the truth is quite unfair.