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Anger Management Style Moderates Effects of Attention Strategy During Acute Pain Induction on Physiological Responses to Subsequent Mental Stress and Recovery: A Comparison of Chronic Pain Patients and Healthy Nonpatients

From the Department of Psychology, Rosalind Franklin University of Medicine and Science (J.W.B.), North Chicago, Illinois; Department of Psychiatry and Behavioral Sciences (P.J.Q.), Johns Hopkins University School of Medicine, Baltimore, Maryland; and the Department of Anesthesiology (S.B.), Vanderbilt University School of Medicine, Nashville, Tennessee.

Address correspondence and reprint requests to John W. Burns, Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064. E-mail: john.burns{at}rosalindfranklin.edu

Objectives: To examine whether high trait anger-out chronic low back (CLBP) patients would show exceptionally large symptom-specific lower paraspinal (LP) responses, compared with healthy nonpatients, during pain induction, a subsequent mental stressor, and recovery when they were urged to suppress awareness of pain and suffering.

Methods: CLBP patients (n = 93) and nonpatients (n = 105) were assigned randomly to one of four attention strategy conditions for use during pain induction: sensory-focus, distraction, suppression, or control. All participants underwent a cold pressor, and then performed mental arithmetic. They completed the anger-out (AOS) and anger-in (AIS) subscales of the Anger Expression Inventory.

Results: General Linear Model procedures were used to test Attention Strategy Condition x Patient/Nonpatient Status x AOS (or AIS) x Period interactions for physiological indices. Significant interactions were found such that: a) high trait anger-out patients in the Suppression condition seemed to show the greatest LP reactivity during the mental arithmetic followed by the slowest recovery compared with other conditions; b) high trait anger-out patients and nonpatients in the Suppression condition seemed to show the slowest systolic blood pressure recoveries compared with other conditions.

Conclusions: Results extend previous work by suggesting that an anger-out style moderates effects of how attention is allocated during pain on responses to and recovery from a subsequent mental stressor. Results provide further evidence that trait anger-out and trait anger-in among CLBP patients are associated with increased LP muscle tension during and after pain and mental stress.

Key Words: attention strategies • acute pain • trait anger-out • symptom-specific reactivity • chronic pain patients

Abbreviations: CLBP = chronic low back pain; EMG = electromyography; AOS = anger-out scale; AIS = anger-in scale; LP = lower paraspinal muscles; SBP = systolic blood pressure; DBP = diastolic blood pressure; HR = heart rate.