At the intersection of anger, chronic pain, and the brain: A mini-review

Chronic pain remains a major healthcare challenge worldwide, yet its underlying causes remain poorly understood. This review focuses on nociplastic pain—a subtype characterized by the absence of clear tissue or nerve damage, including conditions like fibromyalgia and chronic back pain. The authors synthesize research suggesting that anger, emotion regulation, and brain plasticity play critical roles in nociplastic pain development and severity. The paper integrates findings from behavioral studies, neuroimaging research, and emotion science to understand how these factors intersect.

The authors conducted a targeted narrative review of literature spanning clinical pain research, emotion regulation studies, and neuroimaging findings. They examined behavioral studies linking anger expression and suppression to pain outcomes, reviewed functional neuroimaging studies of both nociplastic pain and anger processing, and analyzed how brain regions involved in emotion—particularly the medial prefrontal cortex (mPFC) and amygdala—differ between pain patients and healthy controls. The methodology synthesizes separate but related research domains to propose an integrated biobehavioral model.

Key findings reveal that unhealthy anger expression and suppression correlate with worse nociplastic pain outcomes and greater muscle tension, while improved anger awareness correlates with pain reduction. Crucially, neuroimaging studies suggest that healthy anger regulation involves deactivation of the mPFC and amygdala—the opposite pattern observed in nociplastic pain patients, who show persistent activation in these regions. This inverse relationship suggests a potential neural mechanism linking anger and pain.

The authors propose the Anger, Brain, and Nociplastic Pain (AB-NP) Model, with significant clinical implications. Interventions targeting anger regulation—such as Emotional Awareness and Expression Therapy (EAET)—may normalize activity in emotion-related brain regions and reduce pain. The review highlights the potential for improving chronic pain treatment by addressing anger awareness, healthy anger expression, and brain plasticity alongside traditional pain management approaches.