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

Abstract

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.

Figures

Figure 1

Attention Strategy Condition × AOS (anger-out scale) × Period for LP (low paraspinal) Changes among patients only (values adjusted for baseline LP and patient age). Contr/Lo = patients in control condition with hypothetical AOS values − 1 standard deviation (SD) from mean; Contr/Hi = patients in control condition with hypothetical AOS values + 1 SD from mean; Distract/Lo = patients in distraction condition with hypothetical AOS values − 1 SD from mean; Distract/Hi = patients in distraction condition with hypothetical AOS values + 1 SD from mean; Sensory/Lo = patients in sensory focus condition with hypothetical AOS values − 1 SD from mean; Sensory/Hi = patients in sensory focus condition with hypothetical AOS values + 1 SD from mean; Suppr/Lo = patients in suppression condition with hypothetical AOS values − 1 SD from mean; Suppr/Hi = patients in suppression condition with hypothetical AOS values + 1 SD from mean; LP Changes = simple change scores; CP = cold pressor; MA = mental arithmetic; R1, R3, and R5 = 1 minute, 3 minutes, and 5 minutes into recovery, respectively.

Figure 2

Attention Strategy Condition × AOS (anger-out scale) × Period for SBP (systolic blood pressure) Changes collapsed across patients and nonpatients (values adjusted for baseline SBP and participant age). Contr/Lo = participants in control condition with hypothetical AOS values − 1 standard deviation (SD) from mean; Contr/Hi = participants in control condition with hypothetical AOS values + 1 SD from mean; Distract/Lo = participants in distraction condition with hypothetical AOS values − 1 SD from mean; Distract/Hi = participants in distraction condition with hypothetical AOS values + 1 SD from mean; Sensory/Lo = participants in sensory focus condition with hypothetical AOS values − 1 SD from mean; Sensory/Hi = participants in sensory focus condition with hypothetical AOS values + 1 SD from mean; Suppr/Lo = participants in suppression condition with hypothetical AOS values − 1 SD from mean; Suppr/Hi = participants in suppression condition with hypothetical AOS values + 1 SD from mean; SBP Changes = simple change scores; CP = cold pressor; MA = mental arithmetic; R1, R3, and R5 = 1 minute, 3 minutes, and 5 minutes into recovery, respectively.

Figure 3

Attention Strategy Condition × AOS (anger-out scale) × Period for HR (heart rate) Changes among patients only (values adjusted for baseline HR and patient age). Contr/Lo = patients in control condition with hypothetical AOS values − 1 standard deviation (SD) from mean; Contr/Hi = patients in control condition with hypothetical AOS values + 1 SD from mean; Distract/Lo = patients in distraction condition with hypothetical AOS values − 1 SD from mean; Distract/Hi = patients in distraction condition with hypothetical AOS values + 1 SD from mean; Sensory/Lo = patients in sensory focus condition with hypothetical AOS values − 1 SD from mean; Sensory/Hi = patients in sensory focus condition with hypothetical AOS values + 1 SD from mean; Suppr/Lo = patients in suppression condition with hypothetical AOS values − 1 SD from mean; Suppr/Hi = patients in suppression condition with hypothetical AOS values + 1 SD from mean; HR Changes = simple change scores; CP = cold pressor; MA = mental arithmetic; R1, R3, and R5 = 1 minute, 3 minutes, and 5 minutes into recovery, respectively.

Figure 4

Patient/Nonpatient Status × AIS (anger-in scale) × Period for LP (low paraspinal) Changes collapsed across attention strategy condition (values adjusted for baseline LP and participant age). Nonpat/Lo = nonpatients with hypothetical AIS values − 1 standard deviation (SD) from mean; Nonpat/Hi = nonpatients with hypothetical AIS values + 1 SD from mean; Patient/Lo = patients with hypothetical AIS values − 1 SD from mean; Patient/Hi = patients with hypothetical AIS values + 1 SD from mean. LP Changes = simple change scores; CP = cold pressor; MA = mental arithmetic; R1, R3, and R5 = 1 minute, 3 minutes, and 5 minutes into recovery, respectively.