Associations between daily chronic pain intensity, daily anger expression, and trait anger expressiveness: An ecological momentary assessment study

Abstract

Links between elevated trait anger expressiveness (anger-out) and greater chronic pain intensity are well documented, but pain-related effects of expressive behaviors actually used to regulate anger when it is experienced have been little explored. This study used ecological momentary assessment methods to explore prospective associations between daily behavioral anger expression and daily chronic pain intensity. Forty-eight chronic low back pain (LBP) patients and 36 healthy controls completed electronic diary ratings of momentary pain and behavioral anger expression in response to random prompts 4 times daily for 7 days. Across groups, greater trait anger-out was associated with greater daily behavioral anger expression (P < 0.001). LBP participants showed higher levels of daily anger expression than controls (P < 0.001). Generalized estimating equation analyses in the LBP group revealed a lagged main effect of greater behavioral anger expression on increased chronic pain intensity in the subsequent assessment period (P < 0.05). Examination of a trait × situation model for anger-out revealed prospective associations between elevated chronic pain intensity and later increases in behavioral anger expression that were restricted largely to individuals low in trait anger-out (P < 0.001). Trait × situation interactions for trait anger suppression (anger-in) indicated similar influences of pain intensity on subsequent behavioral anger expression occurring among low anger-in persons (P < 0.001). Overlap with trait and state negative affect did not account for study findings. This study for the first time documents lagged within-day influences of behavioral anger expression on subsequent chronic pain intensity. Trait anger regulation style may moderate associations between behavioral anger expression and chronic pain intensity.

Anger arousal and behavioral anger regulation in everyday life among patients with chronic low back pain: Relationships to patient pain and function.

“…Regarding the regulation of anger, present findings are consistent with those of Bruehl et al (2012) in that lagged analyses in the present study revealed that increases in patient behavioral anger expression (above their own mean) were related to increases in pain intensity three hours later. Extending previous work, we also show for the first time that behavioral anger expression was related to increases in interference due to pain and downtime three hours later.…”

Anger regulation style, anger arousal and acute pain sensitivity: evidence for an endogenous opioid “triggering” model

“…High trait anger-out people may exhibit even greater pain sensitivity when angered prior to pain-induction because of enhanced pain perception associated with simultaneous experience of strong negative affect (anger) in the absence of effective compensatory opioidergic pain modulation. These laboratory effects are supported by results from an ecological momentary assessment diary study of chronic pain patients (Bruehl, Liu, Burns, Chont, & Jamison, 2012). Here, increased momentary behavioral anger expression when the person was angered appeared to predict increased chronic pain intensity in the subsequent 4 h period.…”

“…Anger arousal may magnify subsequent pain sensitivity among individuals high in anger-out due to pain enhancing perceptual effects of anger without adequate compensatory endogenous opioid inhibitory function (Bruehl et al, 2012; Burns et al, 2004). Alternatively, anger arousal may trigger opioid release selectively among high anger-out people (Burns et al, 2003).…”

An Integrated Model of Chronic Whiplash-Associated Disorder

“…The mechanisms of such may be genetic, 9,69 or may be related to conditioning through prior life experience. 123 Recent work has revealed that a perception of being the victim of injustice 102,103 or anger management/expression style 12,16 is associated with the experience and/or expression of pain and disability that can be included at this stage. The parallel pathway indicating possible involvement of the central nervous system comes from emerging evidence that WAD shares many clinical and lab-based characteristics with either mild traumatic brain injury 28 or subclinical damage to spinal white matter tracts 32,93 in at least a discrete number of patients.…”