From Our 2010 Archives
Anger Increases Pain in Women
Negative Emotions Worsen Pain in Women With and Without Fibromyalgia, Researchers Say
By Bill Hendrick
Reviewed by Laura J. Martin, MD
Sept. 24, 2010 -- Negative emotions such as anger and sadness increase pain in women who suffer from fibromyalgia and in those who don't, according to a new study.
Researchers in the Netherlands conducted experiments on a total of 121 women, 62 with fibromyalgia, a chronic pain condition, and 59 who don't have the disorder.
Both groups were asked to recall a neutral situation, then recall anger and sadness-inducing conditions. The effects of these negative emotions on pain responses were measured. The participants were also subjected to electrical pain induction, where they pressed a button when they felt an electrical current and again when it became painful and once again when intolerable.
The researchers found that women with and without fibromyalgia indicated increased pain in response to both anger and sadness. A greater emotional reaction was associated with a greater amount of pain response.
“Emotional sensitization of pain may be especially detrimental in people who already have high pain levels,” says Henriet van Middendorp, PhD, of Utrecht University in the Netherlands. “Research should test techniques to facilitate better emotional regulation, emotional awareness, experiencing, and processing.”
Middendorp tells WebMD by email that the study findings are most relevant for women with fibromyalgia because they experience negative emotions more frequently than women without the condition.
She says that because “negative emotions are an unavoidable part of life, especially when you are dealing with chronic pain, it could be worthwhile to focus on trying to change the way people deal with their emotions in order to try to change the impact that negative emotions have on pain.”
For example, she tells WebMD, “teaching patients to recognize their emotions and to express them may decrease the intensity with which the emotions are experienced, which will also decrease the impact of emotions on pain.”
Although it's true that anger and sadness increase pain in women with fibromyalgia, researcher Mark A. Lumley, PhD, of Wayne State University tells WebMD that there are “some caveats.”
He says that researchers were “unable to measure the patients' experience of either anger or sadness, nor how intense the emotion was or how clearly and definitively it was experienced.”
It is possible, he says by telephone, that when asked to express anger, patients with fibromyalgia “were not able to give as clearly angry a story and to express their feelings directly.”
It's likely, he says, that those patients “had more difficulty giving a specifically angry experience and then expressing it. If so, then this could result in no differences between the fibromyalgia patients and controls.”
Lumley tells WebMD that there is evidence that women with fibromyalgia “have greater difficulty identifying feelings, expressing feelings, and that anger that is inhibited is particularly problematic for patients with fibromyalgia and other chronic pain conditions.”
The findings are “a little surprising,” he tells WebMD, because he “would have expected fibromyalgia patients to show a greater increase in how much they reported experiencing sadness and anger” because “they tend on average to have more negative emotions.”
In a related study, researchers at Radboud University Nijmegen Medical Center, also in the Netherlands, found that tailored cognitive-behavioral therapy and exercise training aimed at helping pain may be beneficial treatments for fibromyalgia patients.
Treatment effects were significant, showing positive differences in pain, fatigue, and functional disability, and in anxiety and negative mood, the researchers say. “Our results demonstrate that offering high-risk [fibromyalgia] patients a treatment tailored to their cognitive behavioral patterns at an early stage after the diagnosis is effective in improving both short- and long-term physical and psychological outcomes,” researcher Saskia van Koulil, MSc, of Radboud says in a news release. “Supporting evidence of the effectiveness of our tailored treatment was found with regard to the follow-up assessments and the low dropout rates,” she says.
Both studies are published online in advance of the October print issue of Arthritis Care & Research.
SOURCES: News release, Wiley-Blackwell.Van Middendorp, H. Arthritis Care & Research, October, 2010Van Koulil, S. Arthritis Care & Research, October 2010.Mark A. Lumley, PhD, Department of Psychology, Wayne State University (phone interview and email exchange).