Many of us have felt pain in one form or another. Often, those jabs are paired with a sense of anger, whether it’s toward a person or inanimate object that caused the pain, or something else. But new research suggests that this anger, when unregulated, can make the pain worse, creating a vicious feedback loop.
Publishing their findings in a recent issue of The Journal of Pain, scientists from Israel, Austria, and the United States suggest that a combination of anger with a feeling of injustice is even more potent than anxiety or depression in fanning the flames of chronic pain and increasing its interference with daily life.
“Anger is not inherently bad,” said Gadi Gilam, a co-author and neuroscientist at The Hebrew University of Jerusalem, in a statement. “It is a common daily emotional signal, and can promote personal and inter-personal well-being when regulated well. But when anger mixes with a sense of injustice, which in itself is a trigger for angry reactions, it can trap people in a cycle of emotional and physical suffering that amplifies and maintains chronic pain.”
Read more: “Antonio Damasio Tells Us Why Pain Is Necessary”
Gilam and his colleagues studied more than 730 adults who had some variety of chronic pain. By surveying these participants the researchers constructed four different “anger profiles.” These included “LALI” (low anger/low injustice), “MAMI” (medium anger/medium injustice), “MALI” (medium anger, low injustice), and “HAHI” (high anger/high injustice). The groupings reflected not only the feelings of the volunteers, but also the ways that they expressed and controlled their anger.
Patients with HAHI and MAMI profiles fared worse than those in the other groups in terms of their chronic pain outcomes.
The scientists also found that anger profiles not only worsened a person’s chronic pain: Those profiles could predict outcomes. By following more than 240 of the study participants for about five months after their initial survey answers, the authors suggest that anger profiles dictated how much pain they felt, how much it interfered with their daily lives, and how it shaped their behavior.
This information could be used by doctors to construct anger profiles in patients experiencing chronic pain and then to tailor interventions that treat not only their pain but their ire. “Clinically, early identification and targeted management of maladaptive anger may improve pain outcomes and reduce disability over time,” the authors write.
“We currently do not have a good enough understanding of the neurobiology underlying chronic pain,” Gilam added. “We do not have a simple pill to cure it, nor do we have strong assessment tools to predict whose pain will persist. Integrating anger and injustice assessments into chronic pain treatment could fundamentally improve outcomes.” 
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