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At the intersection of anger, chronic pain, and the brain: A mini-review
Bottom line: anger and an angry disposition can affect the brain in ways that make chronic pain more likely.
According to Dr. Yarns, the key takeaway from his team’s review is the illustration that anger regulation is clearly an important treatment target for nociplastic pain conditions.
“Specifically, when a pain patient gets angry, becoming aware of the feeling and allowing it to pass without immediately acting on it and without undue distress – anger awareness – could reduce pain by opposing the brain circuits involved in the generation and maintenance of many forms of chronic pain,” he said. “The fact that it teaches this form of anger awareness could be one way that EAET is so effective to reduce or even eliminate chronic pain,” he added.
As for adopting the model in clinical practice, “I think the biggest barrier is skepticism by both patients and providers about how important the brain, emotions, and emotion regulation are to most forms of chronic pain,” Dr. Yarns told PPM. “Since patients feel chronic pain in their bodies, most assume something is wrong with their bodies, but that is not always the case,” he said. “Emotional brain circuits affect the experience of all pain, and brain imaging research shows that changes in these circuits may cause nociplastic pain,” he emphasized. “Therefore, treatments for these conditions should intervene on the levels of emotion and the brain more than the body, which is where the pain is often felt, but not always where it is caused,” he explained.
“Pain management providers also frequently focus on body-based treatments such as injections, devices, and physical therapy, and most psychological/brain-based treatments only focus on coping with or accepting the pain,” said Dr. Yarns. However, “our review suggests that at least one emotional process – anger awareness – could directly oppose the brain circuits that generate and maintain nociplastic chronic pain, and therefore reduce it,” he said.