Anger management style and emotional reactivity to noxious stimuli among chronic pain patients and healthy controls: the role of endogenous opioids.
OBJECTIVE
Previous work suggests that elevated trait anger-out exacerbates pain responses in part through endogenous opioid dysfunction. The authors examined whether this opioid dysfunction affects not only perceived pain intensity, but also emotional responses to being hurt.


METHODS
79 chronic low back pain (LBP) patients and 46 healthy controls received opioid blockade (8 mg naloxone i.v.) and placebo in randomized, counterbalanced order in separate sessions. During each session, participants sequentially experienced finger pressure pain and ischemic forearm pain tasks, with emotional state assessed at baseline and postpain.


METHODS
Blockade effects indexing opioid modulation of emotional reactivity were derived by subtracting placebo from blockade condition emotional reactivity.


RESULTS
Significant Participant Type x Anger-Out interactions on blockade effects indicated that in LBP participants but not in controls, greater anger-out was associated with deficient opioid modulation of anxiety, anger, and fear reactivity to noxious stimulation. Across participant types, greater anger-in was associated with impaired opioid modulation of anxiety and fear reactivity. Anger-in opioid effects were partially due to overlap with general negative affect.


CONCLUSIONS
Opioid dysfunction associated with trait anger-out may affect not only perceived pain intensity, but also pain-related suffering in individuals with chronic pain conditions. Implications for understanding the health effects of anger management styles are discussed.
Bruehl
Stephen
S
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37212, USA. Stephen.Bruehl@vanderbilt.edu
Burns
John W
JW
Chung
Ok Y
OY
Quartana
Phillip
P
D000328:Adult; D000786:Anger / Q000187:drug effects / Q000502:physiology*; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology; D001143:Arousal / Q000187:drug effects / Q000502:physiology*; D001416:Back Pain / Q000503:physiopathology* / Q000523:psychology; D002605:Character; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004644:Emotions / Q000187:drug effects / Q000502:physiology*; D005239:Fear / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009270:Naloxone / Q000494:pharmacology; D009292:Narcotic Antagonists / Q000494:pharmacology; D018847:Opioid Peptides / Q000502:physiology*; D017288:Pain Threshold / Q000187:drug effects / Q000502:physiology
D009292:Narcotic Antagonists; D018847:Opioid Peptides; D009270:Naloxone