Anger and feelings of injustice exacerbate chronic pain

Researchers have identified four different 'anger profiles' in people with chronic pain and shown that those who feel hurt, unfairly treated or deprived of something important because of their condition are more likely to experience more severe and persistent pain months after the initial assessment.

The work was carried out by an international team led by Dr Gadi Gilam, head of the tSCAN (translational Social, Cognitive, and Affective Neuroscience) laboratory at the Institute for Biomedical and Dental Research at the Hebrew University of Jerusalem. The study is published in The Journal of Pain.

Four "anger profiles" and their relationship to pain

The study involved more than 700 adults with chronic pain of various origins who sought treatment. Using the latent profiling method (latent profile analysis), the scientists identified four types of emotional response that describe:

• how the person experiences anger,

• how they express and control it,

• how strongly they feel the unfairness of the situation ("I was bypassed", "I lost something irrevocably because of the pain").

Results:

• those who demonstrated moderate/high levels of anger and a pronounced sense of injustice fared worst;

• these patients reported:

  • greater pain intensity,

  • more widespread pain throughout the body,

  • more restrictions in daily life,

  • higher levels of emotional distress;

• in contrast, people who had better anger regulation and less perception of their situation as "unfair" or "hurtful" felt markedly better on average.

"Anger itself is not 'bad'," Dr Gilam emphasises. - It's a normal everyday emotional cue that, when regulated normally, can even help both the person and their relationships. But when anger is mixed with feelings of injustice, it can drive a person into a cycle of emotional and physical suffering that intensifies and perpetuates chronic pain."

Pain prediction months ahead

The researchers tracked a portion of the participants (242 people) for about five months. It turned out that the highlighted "anger profiles" predicted future pain scores and functioning, even when levels of anxiety and depression were taken into account.

This means that:

• an assessment of exactly how angry a person is and feels about injustice,

• can be an early marker of risk for long-term, severe chronic pain;

• and therefore offers a chance to proactively highlight patients who are in particular need of emotionally-focused treatment approaches.

"How patients feel emotionally about their pain - especially whether they consider it 'unfair' - may be as important as biological causes," Gilam notes. - "We don't yet have a simple 'pill' for chronic pain, nor do we have reliable tools to predict who's pain will take hold." Incorporating anger assessment and feelings of injustice into the standard of care could seriously improve outcomes."

What this means for treatment

The authors emphasise: the results support the need for individualised psychological and psychotherapeutic interventions aimed at:

• emotion regulation,

• processing the experience of injustice and offence,

• changing attitudes towards one's own pain and life situation.

Among the approaches that may be helpful are:

• Emotional Awareness and Expression Therapy,

• various compassion-focused therapies,

• and other methods to help people live anger safely and reduce fixation on the feeling of "I've been hurt" or "I've been wronged".

The authors believe that understanding the "many faces" of anger can be an important step toward treating not only the symptoms but also the person, with their emotions, experiences, and perceptions of pain.