Associations Between Daily Chronic Pain Intensity, Daily Anger Expression, and Trait Anger Expressiveness: an Ecological Momentary Assessment Study

Overview

Journal Pain

Specialties Neurology
Psychiatry

Date 2012 Sep 4

PMID 22940462

Citations 28

Authors

Stephen Bruehl

XiaoXia Liu

John W Burns

Melissa Chont

Robert N Jamison

Affiliations

Soon will be listed here.

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.

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References

Beck A, Ward C, Mendelson M, Mock J, ERBAUGH J . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004. View

Burns J, Quartana P, Bruehl S . Anger inhibition and pain: conceptualizations, evidence and new directions. J Behav Med. 2008; 31(3):259-79. DOI: 10.1007/s10865-008-9154-7. View

Burns J, Kubilus A, Bruehl S . Emotion induction moderates effects of anger management style on acute pain sensitivity. Pain. 2003; 106(1-2):109-18. DOI: 10.1016/s0304-3959(03)00298-7. View

Bruehl S, McCubbin J, Harden R . Theoretical review: altered pain regulatory systems in chronic pain. Neurosci Biobehav Rev. 1999; 23(6):877-90. DOI: 10.1016/s0149-7634(99)00039-1. View

Gelkopf M . Laboratory pain and styles of coping with anger. J Psychol. 1997; 131(1):121-3. DOI: 10.1080/00223989709603510. View

Bruehl S, Chung O, Burns J . Differential effects of expressive anger regulation on chronic pain intensity in CRPS and non-CRPS limb pain patients. Pain. 2003; 104(3):647-654. DOI: 10.1016/S0304-3959(03)00135-0. View

Burns J, Bruehl S . Anger management style, opioid analgesic use, and chronic pain severity: a test of the opioid-deficit hypothesis. J Behav Med. 2005; 28(6):555-63. DOI: 10.1007/s10865-005-9020-9. View

Stone A, Broderick J, Shiffman S, Schwartz J . Understanding recall of weekly pain from a momentary assessment perspective: absolute agreement, between- and within-person consistency, and judged change in weekly pain. Pain. 2004; 107(1-2):61-9. DOI: 10.1016/j.pain.2003.09.020. View

Marceau L, Link C, Jamison R, Carolan S . Electronic diaries as a tool to improve pain management: is there any evidence?. Pain Med. 2007; 8 Suppl 3:S101-9. DOI: 10.1111/j.1526-4637.2007.00374.x. View

10.

Materazzo F, Cathcart S, Pritchard D . Anger, depression, and coping interactions in headache activity and adjustment: a controlled study. J Psychosom Res. 2000; 49(1):69-75. DOI: 10.1016/s0022-3999(00)00144-6. View

11.

Lombardo E, Tan G, Jensen M, Anderson K . Anger management style and associations with self-efficacy and pain in male veterans. J Pain. 2005; 6(11):765-70. DOI: 10.1016/j.jpain.2005.07.003. View

12.

Bruehl S, Chung O, Burns J, Biridepalli S . The association between anger expression and chronic pain intensity: evidence for partial mediation by endogenous opioid dysfunction. Pain. 2003; 106(3):317-324. DOI: 10.1016/S0304-3959(03)00319-1. View

13.

Wasan A, Wootton J, Jamison R . Dealing with difficult patients in your pain practice. Reg Anesth Pain Med. 2005; 30(2):184-92. DOI: 10.1016/j.rapm.2004.11.005. View

14.

Stone A, Broderick J, Porter L, Kaell A . The experience of rheumatoid arthritis pain and fatigue: examining momentary reports and correlates over one week. Arthritis Care Res. 1997; 10(3):185-93. DOI: 10.1002/art.1790100306. View

15.

Bruehl S, Chung O, Burns J, Diedrich L . Trait anger expressiveness and pain-induced beta-endorphin release: support for the opioid dysfunction hypothesis. Pain. 2007; 130(3):208-215. PMC: 2680320. DOI: 10.1016/j.pain.2006.11.013. View

16.

Engebretson T, Matthews K, Scheier M . Relations between anger expression and cardiovascular reactivity: reconciling inconsistent findings through a matching hypothesis. J Pers Soc Psychol. 1989; 57(3):513-21. DOI: 10.1037//0022-3514.57.3.513. View

17.

Genazzani A, Nappi G, Facchinetti F, Micieli G, Petraglia F, Bono G . Progressive impairment of CSF beta-EP levels in migraine sufferers. Pain. 1984; 18(2):127-133. DOI: 10.1016/0304-3959(84)90880-7. View

18.

van Middendorp H, Lumley M, Moerbeek M, Jacobs J, Bijlsma J, Geenen R . Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: a diary study. Eur J Pain. 2009; 14(2):176-82. DOI: 10.1016/j.ejpain.2009.03.007. View

19.

Lautenbacher S, Rollman G . Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain. 1997; 13(3):189-96. DOI: 10.1097/00002508-199709000-00003. View

20.

Bruehl S, Chung O . Parental history of chronic pain may be associated with impairments in endogenous opioid analgesic systems. Pain. 2006; 124(3):287-294. DOI: 10.1016/j.pain.2006.04.018. View