Cognitive dimensions of anger in chronic pain

Anger has long been recognized as an integral part of pain experience [1,19]. Reviews highlight the deleterious effect of anger on social, clinical, and functional outcomes [9,22,32]. Anger has been discussed as an aversive emotional state ranging from mild irritation to fury [25], and comprising specific cognitive attributions and action tendencies [21,34]. Anecdotal and empirical data suggest that anger is commonplace among chronic pain sufferers [32]. In their 2003 review, Greenwood et al. [22] identified anger as an important target of research and behavioral management; since that review, research has highlighted biopsychosocial mechanisms through which anger may affect pain experience [5,9,33]. However, to date, no systematic line of research has addressed the cognitive dimensions of anger in chronic pain. We believe that elucidating these facets of anger in pain sufferers might strengthen the empirical foundation for more effective treatment. Although not exhaustive, the current review highlights potential sources of anger among pain sufferers by drawing on conceptualizations from existing social psychological theory and newly evolving lines of research. On this basis, we discuss the role of anger in treatment settings, and possible frameworks for research and intervention.