Anger expression and chronic pain

Kerns, Robert D.; Rosenberg, Roberta; Jacob, Mary Casey

doi:10.1007/bf01856882

Cited by 193 publications

(128 citation statements)

References 31 publications

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“…Several studies supported the evidence that inhibition of anger is related to major pain severity, emotional distress and overt pain behaviours [6,7].…”

mentioning

confidence: 78%

Anger and emotional distress in patients with migraine and tension–type headache

Perozzo¹,

Savi

Castelli

et al. 2005

J Headache Pain

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The objective was to evaluate the prevalence and the characteristics of anger and emotional distress in migraine and tension– type headache patients. Two hundred and one headache patients attending the Headache Center of the University of Turin were selected for the study and divided into 5 groups: (1) migraine, (2) episodic tension–type headache, (3) chronic tension–type headache, (4) migraine associated with episodic tension–type headache and (5) migraine associated with chronic tension–type headache. A group of 45 healthy subjects served as controls. All the subjects completed the State–Trait Anger Expression Inventory, the Beck's Depression Inventory and the Cognitive Behavioral Assessment. Anger control was significantly lower in all headache patients ( p <0.05) except in migraineurs. Patients with migraine and tension–type headache showed a significantly higher level of angry temperament and angry reaction ( p <0.05). In addition, chronic tension–type headache and migraine associated with tension–type headache patients reported a higher level of anxiety ( p <0.05), depression ( p <0.001), phobias ( p <0.001) and obsessive–compulsive symptoms ( p <0.01), emotional liability ( p <0.001) and psychophysiological disorders ( p <0.001). Our study shows that chronic tension–type headache and migraine associated with tension–type headache patients present a significant impairment of anger control and suggests a connection between anger and the duration of headache experience.

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“…Several studies supported the evidence that inhibition of anger is related to major pain severity, emotional distress and overt pain behaviours [6,7].…”

mentioning

confidence: 78%

Anger and emotional distress in patients with migraine and tension–type headache

Perozzo¹,

Savi

Castelli

et al. 2005

J Headache Pain

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“…Research has highlighted the pain-related effects of anger management styles (e.g., Keefe et al, 2001;Kerns et al, 1994;Burns et al, 2003;2004). A recent review indicated that 16/19 published studies supported relationships between elevated trait anger-out (managing anger via direct physical or verbal expression) and either increased acute pain responsiveness or greater levels of chronic pain intensity and dysfunction (Bruehl et al, in press).…”

Section: Introductionmentioning

confidence: 99%

“…A recent review indicated that 16/19 published studies supported relationships between elevated trait anger-out (managing anger via direct physical or verbal expression) and either increased acute pain responsiveness or greater levels of chronic pain intensity and dysfunction (Bruehl et al, in press). Elevated trait anger-in (managing anger through inhibition of expression) has similarly demonstrated associations with increased pain responsiveness (Kerns et al, 1994;Gelkopf, 1997;Bruehl et al, 2002;Burns et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Trait anger expressiveness and pain-induced beta-endorphin release: Support for the opioid dysfunction hypothesis

Bruehl

Chung

Burns

et al. 2007

Pain

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The anger management styles of anger-in (inhibition) and anger-out (direct expression) are positively associated with pain responsiveness. Opioid blockade studies suggest that hyperalgesic effects of trait anger-out, but not those of trait anger-in, are mediated in part by opioid analgesic system dysfunction. The current study tested the opioid dysfunction hypothesis of anger-out using an alternative index of opioid function: pain-induced changes in plasma endogenous opioids. Plasma beta-endorphin (BE) was assessed at rest and again following exposure to three laboratory acute pain tasks (finger pressure, ischemic, and thermal) in 14 healthy controls and 13 chronic low back pain (LBP) subjects. As expected, acute pain ratings correlated positively with measures of anger-in (both groups) and anger-out (LBP group; p's<.05). Greater pain-induced increases in BE were associated with significantly lower pain ratings in both groups (p's <.05). Hierarchical multiple regression indicated that greater anger-out significantly predicted smaller pain-induced BE increases (p<.05). Subject type did not moderate this association (p>.10). Anger-in did not display significant main or interaction effects on pain-induced BE changes (p's >.10). The significant association between angerout and BE release partially mediated the hyperalgesic effects of anger-out on pain unpleasantness, and was not attenuated by statistical control of general negative affect. This suggests unique associations with expressive anger regulation. Elevated trait anger-out therefore appears to be associated with opioid analgesic system dysfunction, whether it is indexed by responses to opioid blockade or by examining circulating endogenous opioid levels. Possible "state × trait" interactions on these anger-related opioid system differences are discussed.

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“…Some patients with chronic pain often express stronger anger towards their family members, doctors, employers, and even themselves than individuals without chronic pain do, and their feelings of anger are reportedly strongly correlated with the intensity of their chronic pain, self-conscious impairments, and the frequency of their pain behaviors [33]. The brain circuit related to anger expression reportedly overlaps with the circuit related to pain [34].…”

Section: Discussionmentioning

confidence: 98%

Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Patients with Chronic Pain

Kasahara¹,

Okamura²,

Matsudaira³

et al. 2017

OJPsych

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Aims: To investigate rates of attention-deficit hyperactivity disorder (ADHD) in patients with chronic pain attending a pain clinic, the effects of a screening measure for ADHD in patients with chronic pain, and the effects of ADHD drugs on both pain and ADHD symptoms. Methods: We retrospectively surveyed 110 patients with chronic pain visiting the Anesthesiology and Pain Relief Center at the University of Tokyo in Japan, who had also consulted a psychiatrist, between April 2012 and July 2015. Results: Of the total of 110 patients with chronic pain, 35 (31.8%) were also diagnosed with ADHD, and the average Wender Utah Rating Scale (WURS) score among the ADHD patients was 39.0 ± 22.1 (n = 25). Only 36.0% of these patients exceeded the cutoff value, suggesting that 64.0% of the patients with ADHD were not identified by screening with the WURS. Twenty-six patients initiated treatment with ADHD medication, with dosage adjustment completed in 21. Of these 21 patients 20 (95.0%) had improved ADHD symptoms. Improved pain symptoms were observed in 14 patients (66.6%), with a reduction in the pain numerical rating scale of 64.7% ± 30.1%. Conclusions: This is the first study investigating the comorbidity of ADHD and chronic pain at pain clinics showing a high level of comorbidity and amelioration of pain and ADHD symptoms with treatment. Careful interpretation is required when the WURS is used to screen patients with chronic pain.

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Anger expression and chronic pain

Cited by 193 publications

References 31 publications

Anger and emotional distress in patients with migraine and tension–type headache

Anger and emotional distress in patients with migraine and tension–type headache

Trait anger expressiveness and pain-induced beta-endorphin release: Support for the opioid dysfunction hypothesis

Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Patients with Chronic Pain

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