Anger

What Is the Link Between Anger and Physical Pain?

Chronic anger can both promote as well as enhance physical pain.

Posted Jul 16, 2021 | Reviewed by Ekua Hagan

KEY POINTS

  • It's natural that people may experience anger as a reaction to pain — whether due to an accident, illness, or the challenges of aging.
  • People often react to physical pain in the same way they react to emotional suffering — through suppression, denial, and distraction.
  • Chronic anger can exacerbate the intensity of one's pain and undermine proper treatment for it.
  • Rather than ignore physical pain or react to it with anger, one can view physical pain as a signal to engage in self-care and self-compassion.

Holding a book wide open, my brother exclaimed, “Mom, look. Read this. It says that repressed anger causes back pain!”

She responded in a dismissive tone, “Leave me alone, I’m making dinner.”

“Really, read this.”

She again expressed her annoyance. After he said it a third time, she raised her voice and yelled, “Just stop it!”

Of course, my brother had to have the last word. “See! It’s true.”

I was 11 at the time and my brother was 14, both budding psychologists even before we knew it. It wasn’t until many years later that I began to explore the interaction between anger and our physical well-being.

Anger as a reaction to pain

Anger stems from a perceived threat to our well-being. It arises physiologically from the activity of the amygdala and hypothalamus in the brain that, when in “red alert,” instigates reactions within us that prepare us for “fight or flight." So it makes perfect sense that physical pain, a very real threat to our emotional and physical well-being, might foster anger arousal. The similarities between physical and emotional pain were supported by a study that used magnetic imaging. It found that social rejection was experienced in the very same areas and with similar patterns in the brain, as occurs with activation of physical pain (Kross, et. al, 2011).

Whether due to an accident, an illness, or challenges associated with aging, physical pain may trigger anger — regarding the specific discomfort, the incapacities associated with it, or its impact on our daily lives. We may react to the pain in the same way we react to emotional wounds. We may direct it inward, experiencing anger with our body for not living up to our expectations of how it should be. We may blame ourselves, as when we feel shame regarding what we did or didn’t do to contribute to our pain. With or without full awareness, we may displace our anger onto others — friends, family, co-workers, strangers, or those we perceive as the “other." And we may even direct anger toward our God.                 

123rf Stock Photo/Boygointer
Pain Meter
Source: 123rf Stock Photo/Boygointer

Anger’s impact on the experience of pain  

How we manage anger regarding physical pain is very much influenced by our cumulative tendency toward anger arousal. This was highlighted by one study that found that perceived injustice, so often associated with anger, contributes to reports of greater pain intensity (Scott, et. al., 2013)

And, yes, suppressing anger has been linked to an increase in pain intensity ratings, perception of sensory and anger-specific elements of pain, and self-reported anger in response to the cold pressor test (a test in which an arm is placed in ice-cold water) (Quartana, et. al., 2010). Additionally, as measured by pre and post-blood pressure levels, suppression was also correlated inversely with systolic blood pressure (SBP). This was further suggested in a study that found individuals characterized as high on anger inhibition (anger-in versus anger-out) experienced greater pain in response to painful electric and cold stimuli (Toledo, et. al., 2019).

Not only can anger exacerbate the experience of pain, but an early study found that it can also have a powerful impact on the course of pain management (1998). This study included 101 chronic pain patients who were enrolled in a pain program. They took pre- and post-treatment measures of lifting capacity, walking endurance, depression, pain severity and activity level. It was found that greater anger was associated with less lifting capacity for males higher on anger expression. Those who tended to suppress anger rated lower in their improvements in depression and general activities.

One study found that in patients with chronic pain, anger arousal and behavioral anger expression in everyday life are associated with elevated pain intensity and decreased function (Burn, et. al., 2015). It was based on reports of individuals with pain, as well as reports of their spouses (in total, 105 couples) who were asked to complete electronic daily diaries, with assessments 5 times each day for two weeks. 

More recently, a mega-study found that perceived injustice was significantly associated with pain intensity, disability and physical function, symptoms of depression and anxiety, posttraumatic stress disorder, quality of life and well-being, and social functioning. This study was performed based on a review of 31 studies that addressed anger, pain, and the sense of injustice (Carriere, et. al., 2020). In total, 5,969 patients with musculoskeletal pain were assessed in these studies. Twenty-three studies reported on patients who had experienced pain for more than 3 months. Seventeen studies included individuals with injury-related pain.

Trait-anger, the ongoing tendency toward anger arousal, entails viewing the world and oneself through constricted filters. These cognitive tendencies inhibit both cognitive and emotional flexibility, a core component of resilience for effectively coping with life’s challenges. I’ve heard many clients report anger arousal with an intensity that is only magnified when viewing it through such a filter. Such reactions may derive from a sense of injustice, from feeling special, or from a history with little (or too much) emotional pain. Regardless of its origins, this perspective fails to recognize that pain is an inherent part of being human.

Thoughts of anger regarding pain, consistent with the concept of neuroplasticity, train the brain to more frequently experience anger as well as the pain. In essence, the neuronal pathways become the carriers of pain. This notion was further supported by a major study in which pain was generated under hypnotic suggestion–in the absence of any true physical damage (Derbyshire, et. al., 2004). It found that both sources of pain entailed activation of the same areas of the brain, thus helping us to better understand how patients might report pain, even in the absence of an observable physical source of such pain.

Personal example

I’ve experienced a fair share of physical pain in recent years, in the form of neuropathy in my legs following radiation for cancer — over 10 years ago. This involves pain as well as some challenges to balancing and coordination. Early on I told myself, “I’m feeling pain. It’s just going to get worse. I’m just getting older. Pretty soon I’ll need a cane, and then a walker, and then a scooter." However, the reality is that I’m fortunate. This is not a condition that necessarily progresses.

So I began to be mindful to my discomfort, to observe it and ignore my mind’s tendency to  “editorialize” about my condition. I’ve learned to say, “Right now, I’m feeling pain. End of story," without further elaboration.

Walking down the street, I could now recognize the discomfort as a sensation and, most often, just accept it and do the best I can. I experience greater capacity to choose to attend to it or instead focus on all of life that is going on around me while walking down that street.

This approach is certainly more challenging at greater intensities of pain (as when I had a kidney stone). However, the challenge is to remember that anger is physiologically destructive for our bodies and can exacerbate our pain. And further, that the meaning we give it, the filter through which we perceive it, can not only exacerbate our suffering, but also inhibit seeking the self-care to address it.

Learning to better manage our anger can have a meaningful impact on reducing and even preventing pain. And when pain does arise, instead of reacting to it with anger, we can view it as a signal to engage in self-care, just as when we experience emotional suffering. This includes learning strategies for self-care and self-compassion, and being an active researcher on one’s own behalf, assertively finding ways to manage the pain. It’s important to remember that pain is not a character flaw. Rather, it is a part of being human.

References

Kross, E., Berman, M., Mischel, W. et. al. (2011) Social rejection shares somatosensory representations with physical pain. PNAS (Proceedings of the National Academy of Sciences of the United States of America); 108 (15) 6270-6275. doi.org/10.1073/pnas.1102693108

Scott, W., Trost, A., Bernier, E., et. al. (2013) Anger differentially mediates the relationship between perceived injustice and chronic pain. J. Pain; 154 (9): 1691-1698.

Quartana, P, Bounds, S., Yoon, K., et. al. (2010). Anger suppression predicts pain, emotional, and cardiovascular responses to the cold pressor. Annals of Behavioral Medicine; Vol. 39, p. 211-221.

Burns, J., Johnson, B., Devine, J., et. al. (1998) Anger management style and prediction of treatment outcome among male and female pain patients. Behaviour Research and Therapy; Vol. 36 (11), 1051-1062.

Burns, J., Gerhart, J., Bruehl, S., et. al. (2015) Anger arousal and behavioral anger regulation in everyday life among patients with chronic low back pain: Relationships to patient pain and function. Health Psychology; Vol. 34 (5) 547-555.

Carriere, J., Pimentel, S, Yakabov, E., et. al. (2020) A systematic review of the association between perceived injustice and pain-related outcomes in individuals with musculoskeletal pain. Pain Medicine: Vol. 21(7), 1449-1463.

Derbyshire, S., Whalley, G., Stenger, A., et. al. (2004) Cerebral activation during hypnotically induced and imagined pain. Neuroimage; Vol. 23 (1), 392-401.