- Study in more than 700 people with chronic pain identified four distinct anger profiles
- Those with high anger and strong feelings of injustice experienced the worst pain outcomes
- These profiles predicted pain severity months later, not just at a single time point
Most people know that stress can aggravate pain. New work from an international team led by the Hebrew University of Jerusalem suggests that anger, especially when combined with a feeling of being treated unfairly, may be even more damaging.
The study, published in The Journal of Pain, examined how different patterns of anger relate to the intensity and persistence of chronic pain.
The findings point to anger as a powerful predictor of who will continue to suffer and who may improve.
Chronic pain is common in diabetes, whether due to neuropathy, joint problems, back pain or other causes.
Frustration at complications, repeated clinic visits and perceived lack of understanding from others can easily fuel anger and a sense of injustice.
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Four anger profiles
Researchers recruited more than 700 adults seeking help for chronic pain caused by a range of conditions.
Participants completed detailed questionnaires about their pain, mood and how they experienced, expressed and controlled anger.
Using a statistical method called latent profile analysis, the team identified four distinct anger profiles.
These profiles reflected not only how often people felt angry, but also how much they felt wronged or believed their pain represented an injustice.
Individuals with medium to high levels of both anger and perceived injustice formed the group with the worst outcomes.
They reported more intense pain, pain that spread to more body areas and higher levels of disability and emotional distress.
Those who felt less wronged and who managed their anger more effectively tended to have milder symptoms and better functioning.
Anger predicts future pain
To see whether these profiles mattered over time, the researchers followed a subset of 242 participants for about five months.
They looked at whether baseline anger patterns predicted later pain, even after accounting for anxiety and depression.
The answer was yes.
People in the high anger and high injustice group were more likely to continue experiencing severe and disruptive pain months later.
Their anger profile gave extra predictive power beyond traditional mood measures.
In other words, how someone feels about their pain, and whether they see it as unfair or as an irreparable loss, appears to shape their physical experience in a lasting way.
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Implications for treatment
These findings have clear clinical implications.
Chronic pain services often focus on physical therapies, medicines and general psychological support.
The new work suggests that specific assessment of anger and perceived injustice could help identify people at risk of long term high impact pain.
Therapies that address emotional regulation and feelings of unfairness, such as Emotional Awareness and Expression Therapy or compassion focused approaches, may have a bigger role to play.
Tailoring treatment to a person’s anger profile could improve outcomes and reduce suffering.
