Bruehl Stephen, Chung Ok Yung, Burns John W
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Psychology, Finch University of Health Sciences/Chicago Medical School, North Chicago, IL, USA.
Pain. 2003 Aug;104(3):647-654. doi: 10.1016/S0304-3959(03)00135-0.
Research has shown that the anger management styles of both anger-in (suppression of anger) and anger-out (direct verbal or physical expression of anger) may be associated with elevated chronic pain intensity. Only the effects of anger-out appear to be mediated by increased physiological stress responsiveness. Given the catecholamine-sensitive nature of pain mechanisms in complex regional pain syndrome (CRPS), it was hypothesized that anger-out, but not anger-in, would demonstrate a stronger relationship with chronic pain intensity in CRPS patients than in non-CRPS chronic pain patients. Thirty-four chronic pain patients meeting IASP criteria for CRPS and 50 non-CRPS (predominantely myofascial) limb pain patients completed the McGill Pain Questionnaire-Short Form (MPQ), the Anger Expression Inventory (AEI), and the Beck Depression Inventory (BDI). Analyses revealed no diagnostic group differences in mean scores on the anger-in (AIS) and anger-out (AOS) subscales of the AEI, or on the BDI (values of P>0.10). Results of general linear model analyses revealed significant AOS x diagnostic group interactions on both the sensory (MPQ-S) and affective (MPQ-A) subscales of the MPQ (values of P<0.05). In both cases, higher AOS scores were associated with more intense chronic pain in the CRPS group, but with less intense pain in the non-CRPS limb pain group. Inclusion of BDI scores as a covariate did not substantially alter the AOS x diagnostic group interactions, indicating that these AOS interactions were not due solely to overlap with negative affect. Although higher AIS scores were associated with elevated MPQ-A pain intensity as a main effect (P<0.05), no significant AIS x diagnostic group interactions were detected (values of P>0.10). The AIS main effect on MPQ-A ratings was accounted for entirely by overlap with negative affect. Results are consistent with a greater negative impact of anger-out on chronic pain intensity in conditions reflecting catecholamine-sensitive pain mechanisms, presumably due to the association between anger-out and elevated physiological stress responsiveness. These results further support previous suggestions that anger-in and anger-out may affect pain through different mechanisms.
研究表明，“向内愤怒”（抑制愤怒）和“向外愤怒”（直接通过言语或身体表达愤怒）这两种愤怒管理方式都可能与慢性疼痛强度升高有关。只有“向外愤怒”的影响似乎是通过生理应激反应性增加来介导的。鉴于复杂区域疼痛综合征（CRPS）中疼痛机制对儿茶酚胺敏感的特性，研究假设，与非CRPS慢性疼痛患者相比，“向外愤怒”而非“向内愤怒”会在CRPS患者中表现出与慢性疼痛强度更强的关联。34名符合国际疼痛研究协会（IASP）CRPS标准的慢性疼痛患者和50名非CRPS（主要为肌筋膜性）肢体疼痛患者完成了麦吉尔疼痛问卷简表（MPQ）、愤怒表达量表（AEI）和贝克抑郁量表（BDI）。分析显示，在AEI的“向内愤怒”（AIS）和“向外愤怒”（AOS）分量表或BDI上，诊断组之间的平均得分没有差异（P>0.10）。一般线性模型分析结果显示，在MPQ的感觉（MPQ-S）和情感（MPQ-A）分量表上，AOS与诊断组之间存在显著交互作用（P<0.05）。在这两种情况下，较高的AOS得分与CRPS组中更强烈的慢性疼痛相关，但与非CRPS肢体疼痛组中较轻的疼痛相关。将BDI得分作为协变量纳入并没有实质性改变AOS与诊断组之间的交互作用，这表明这些AOS交互作用并非仅仅由于与消极情绪的重叠所致。尽管较高的AIS得分作为主要效应与MPQ-A疼痛强度升高相关（P<0.05），但未检测到显著的AIS与诊断组之间的交互作用（P>0.10）。AIS对MPQ-A评分的主要效应完全是由于与消极情绪的重叠所致。研究结果与“向外愤怒”在反映儿茶酚胺敏感疼痛机制的情况下对慢性疼痛强度有更大负面影响一致，推测这是由于“向外愤怒”与生理应激反应性升高之间的关联。这些结果进一步支持了先前的观点，即“向内愤怒”和“向外愤怒”可能通过不同机制影响疼痛。
