Measuring anger in patients experiencing chronic pain - A systematic review

Abstract

Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior and treatment outcome. Objectives were (1) to survey in the context of chronic pain the application (and omission) of validated anger self-report instruments, (2) to discuss the instruments found in the context of emotion theories and (3) to identify a possible instrument preference. A systematic search of textbooks and review articles was first performed on validated instruments designed to measure the cognitive, the motivational and the subjective feeling component of anger. Thereafter, a systematic review aimed at finding chronic pain studies from 2005 to 2019 reporting on these instruments. Textbooks and reviews listed 16 validated self-report anger measurement instruments. 28 papers applying four of these were identified and two new instruments were additionally detected. The State-Trait Anger Expression (STAXI) and its precursors were most commonly used. Studies on chronic low back pain patients prevailed. In conclusion, anger in chronic pain patients is reliably measurable at low cost with self-report tools. The STAXI-II qualifies best for this purpose based on its extensive validation history. The majority of instruments lack sufficient theoretical and psychometric adequacy. A more detailed exploration of the cognitive anger component in chronic pain patients in future research is recommended.

Is psychological distress associated with carpal tunnel syndrome symptoms and nerve conduction study findings? A case–control study from Syria

“…In general, the association between pain and anger was highly reported in previous studies. Anger exacerbates pain intensity in both, chronic and acute conditions (Estlander et al., 2008 ; Greenwood et al., 2003 ), and vice versa was true as a systematic review stated that patients experiencing chronic pain reported higher degrees of anger in comparison to controls (Sommer et al., 2019 ). This study provides new insight into anger as its association with CTS is never studied before.…”

Self‐compassion predicting pain, depression and anger in people suffering from chronic pain: A prospective study

“…One could also find fault with the STAXI, as it did not address pain‐specific anger. Nevertheless, the STAXI is the most commonly used instrument in pain research (Sommer et al., 2019).…”

“…Higher scores indicate a stronger expression of the underlying concept. In the context of chronic pain, the STAXI is the most widely used instrument to assess anger (Sommer, Lukic, Rössler, & Ettlin, 2019). In the present samples, all subscales demonstrate adequate to excellent internal consistency (state anger: Cronbach's α = 0.90-96; trait anger: Cronbach's α = 0.71-87; anger-in: Cronbach's α = 0.78-0.88; anger-out: Cronbach's α = 0.83-0.84; anger-control: Cronbach's α = 0.83-0.92).…”

The Pain–to–Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain

“…Nine items covering different aspects of depression are scored on an ordinal scale ranging from 0 to 3 using the same labels as the GAD7. Summary scores range from 0 to 27, indicating depression levels of "none/minimal" (0-4), "mild" (5-9), "moderate" (10)(11)(12)(13)(14), "moderately severe" (15)(16)(17)(18)(19), or "severe" (>19). A cutoff score range of 8-11 has been recommended for expert evaluation referral.…”

“…Sleep has been proposed as an additional axis II construct because a strong relationship between self-assessed sleep disturbances, OFP, and TMD has been observed (12,13). Perceived injustice, anger, illness perception, catastrophization, and dysmorphophobia are additional potential moderators of the pain-to-well-being relationship (14)(15)(16)(17).…”