title: Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: evaluation of an ironic process model.
abstract: OBJECTIVE
  Evidence for links between anger inhibition or suppression and chronic pain severity is based mostly on studies with correlation designs. Following from ironic process theory, we proposed that attempts to suppress angry thoughts during provocation would increase subsequent pain intensity among chronic low back pain (CLBP) patients, and do so through paradoxically enhanced accessibility of anger.
  
  
  METHODS
  CLBP patients (N = 58) were assigned to suppression and nonsuppression conditions while performing a computer maze task with a harassing confederate. A structured pain behavior task (SPBT) followed.
  
  
  METHODS
  Self-reported anger, anxiety, and sadness following maze task. Self-reported pain severity and number of observed pain behaviors during SPBT.
  
  
  RESULTS
  Patients told to suppress during provocation: (a) reported greater anger following the maze task, reported greater pain intensity during the SPBT, and exhibited more pain behaviors than patients not suppressing; (b) postmaze anger levels significantly mediated group differences on pain behaviors.
  
  
  CONCLUSIONS
  Attempts by CLBP patients to suppress anger may aggravate pain related to their clinical condition through ironically increased feelings of anger.
authors.affiliation: Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA. john.burns@rosalindfranklin.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.forename: Phillip
authors.initials: P
authors.lastname: Quartana
authors.forename: Wesley
authors.initials: W
authors.lastname: Gilliam
authors.forename: Erika
authors.initials: E
authors.lastname: Gray
authors.forename: Justin
authors.initials: J
authors.lastname: Matsuura
authors.forename: Carla
authors.initials: C
authors.lastname: Nappi
authors.forename: Brandy
authors.initials: B
authors.lastname: Wolfe
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lofland
mesh_terms: D000328:Adult; D000786:Anger; D002908:Chronic Disease; D005260:Female; D006801:Humans; D055809:Illness Behavior; D017116:Low Back Pain / Q000175:diagnosis* / Q000523:psychology*; D008297:Male; D010147:Pain Measurement; D011582:Psychological Theory; D012094:Repression, Psychology; D012720:Severity of Illness Index; D014705:Verbal Behavior