When Chronic Pain Leads to Chronic Anger

Anger and Chronic Pain | PainScale

Stress and frustration are common and expected emotions in individuals living with constant pain, but fueled anger can actually make chronic pain worse. Here are ways to combat the cycle.  By Rosemary BlackReviewed By David Cosio, PhD, ABPP and Michael R. Clark, MD, MPH, MBA

Individuals living with pain can experience a range of emotions including anxiety, depression, sadness, and, last but not least, anger.

In fact, 70% of individuals living with chronic pain report feeling angry at themselves and at healthcare professionals,1 says David Cosio, PhD, ABPP, a psychologist in the Interdisciplinary Pain Program at the Jesse Brown VA Medical Center in Chicago and a member of the Practical Pain Management Editorial Board.

Unfortunately, anger is linked to greater pain severity, pain behavior, and muscle tension in people who live with chronic pain.2  In one study, researchers concluded that patients with headaches displayed a significant impairment of anger control and suggested that there is a connection between anger and how long a headache lasts.3You may be interested in these related articles:

It is easy to feel frustrated, stressed, and angry when there is no cause for your chronic pain. (Image: iStock)

Why Pain Fuels Anger and Other Emotions

“When someone suffers from pain for an extended period, this can affect their mood negatively,” Dr. Cosio explains. “These mood changes can negatively impact their levels of activity. People begin to engage in more unhealthy behaviors and less in healthy ones.”

Whether men or women are more likely to be angry is not certain. One study found that men (16.7%) were more likely than women (1.5%) to report anger.4 Yet when Dr. Cosio’s research team conducted a study in 2018 that looked at the prevalence rates of different psychological domains among veterans with chronic pain, they found that women (88%) reported anger more often than men (72%.) “Our findings suggest that anger may be a domain that all frontline providers should actively assess and make treatment recommendations for all their chronic pain patients,” he said.

Anger is a powerful, negative, and physiologically arousing emotion commonly experienced in response to acute pain, adds Gadi Gilam, PhD, a postdoctoral research fellow in the Stanford University School of Medicine’s Department of Anesthesiology, Perioperative and Pain Medicine in Palo Alto, California.

“Most studies indicate that patients with chronic pain tend to be angry,” says Dr. Gilam. “Understandably, they are dealing with a lot of challenges, frustrations, and with the feeling that their suffering is unjust and unfair. However, their anger and the way they express their anger can worsen their chronic pain.”

Anger as a Coping Mechanism

Anger can be a coping mechanism in response to pain but it’s actually counterproductive, agrees Germaine Rowe, MD, a pain management doctor at Healthcare Associates in Medicine on Staten Island, New York. “It puts the body into a state of stress, which causes the release of substances such as adrenaline, cortisol, and C reactive protein, and these chemical mediators cause a chain of events that end up worsening the pain,” she explains.

Individuals living with pain may become angry when they are unable to meet the demands of life and do the things they want to, adds Michael Clark, MD, MPH, MBA, chair of psychiatry and behavioral health at the Inova Health System in Falls Church, Virginia.  The person may be struggling to answer the “Why me?” question, says Dr. Clark, who also serves on PPM’s editorial board.

“They have to figure out a way to process the loss of their former life and to reconnect with their world and realize there is still a path for quality of life to be achieved,” he says. “It’s a matter of doing an inventory of a person’s strengths and weaknesses and helping them to fit into something they can succeed at.”

Strategies to Combat Pain-Driven Anger

Fortunately, there are effective treatments for individuals whose pain may be accentuated by the anger they are feeling. The first step is to determine what you’re feeling, says Dr. Cosio. Fear, sadness, guilt, and shame are common emotions in a person who is in pain. “The person may be uncomfortable with these emotions, so they are quick to anger,” he says. 

Cognitive behavioral therapy

“We teach our patients a 3-step process to address anger,” says Dr. Cosio. Using cognitive behavioral therapy (CBT), the person learns how to become aware of triggers for their anger. Next, they learn how to modify internal responses by using strategies such as relaxation exercises. “We also teach them to respond assertively when expressing an opinion and taking action,” Dr. Cosio explains. “This form of therapy helps the person recognize the self-defeating negative thoughts that lie behind anger flare-ups which in turn, can affect the perception of pain.”

Compassion cultivation training and mindfulness

Another effective strategy for helping to reduce anger is Compassion Cultivation Training, an 8-week program that Laurisa Dill, M.Ed, a Toronto-based registered psychotherapist who runs CCT workshops, says is typically taught for a couple of hours per week. CCT programs are offered around the United States.

CCT aims to help improve resilience, increase empathy and compassion, and cut back on anxiety and stress. Participants are guided to practice daily meditations and they learn techniques to help improve their mood, Dill says. The program has its roots in mindfulness-based programs, she says.

“You can change your outlook and your interpretation of pain and anger by cultivating compassion and mindfulness,” says Dill. “You can reduce stress and depression, increase self-compassion, and support your health and well-being.”

In CCT as well as other mindfulness-based programs, a person is taught that she has the capacity to regulate her nervous system and reduce the stress hormones that can worsen pain, Dill explains. “When we are in a state of caring and compassion, all our stress hormones go down a little bit, and we are less susceptible to the experience of pain,” she adds.Updated on: 05/11/20