Pain-related effects of trait anger expression: Neural substrates and the role of endogenous opioid mechanisms

Bruehl, Stephen; Burns, John W.; Chung, Ok Y.; Chont, Melissa

doi:10.1016/j.neubiorev.2008.12.003

Cited by 89Pain Mechanisms and TreatmentsNeural and Behavioral Psychology StudiesPsychosomatic Disorders and Their Treatments

Pain-related effects of trait anger expression: Neural substrates and the role of endogenous opioid mechanisms

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Bruehl, Stephen, Burns, John W., Chung, Ok Y., Chont, Melissa·2009·Neuroscience & Biobehavioral Reviews

DOI 10.1016/j.neubiorev.2008.12.003PMC PMC2756489

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Abstract

Literature is reviewed indicating that greater tendency to manage anger via direct verbal or physical expression (trait anger-out) is associated with increased acute and chronic pain responsiveness. Neuroimaging data are overviewed supporting overlapping neural circuits underlying regulation of both pain and anger, consisting of brain regions including the rostral anterior cingulate cortex, orbitofrontal cortex, anterior insula, amygdala, and periaqueductal gray. These circuits provide a potential neural basis for observed positive associations between anger-out and pain responsiveness. The role of endogenous opioids in modulating activity in these interlinked brain regions is explored, and implications for understanding pain-related effects of anger-out are described. An opioid dysfunction hypothesis is presented in which inadequate endogenous opioid inhibitory activity in these brain regions contributes to links between trait anger-out and pain. A series of studies is presented that supports the opioid dysfunction hypothesis, further suggesting that gender and genetic factors may moderate these effects. Finally, possible implications of interactions between trait anger-out and state behavioral anger expression on endogenous opioid analgesic activity are described.

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More than 80% of published studies indicate that elevated trait anger-out is associated with greater chronic pain intensity and greater chronic pain-related dysfunction.
“Although some null findings have been reported, more than 80% of published studies indicate that elevated trait anger-out is associated with greater CP intensity and greater CP-related dysfunction.61”
From <p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p> (2020) · cites this paper as [61]

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The association between anger expression and chronic pain intensity: evidence for partial mediation by endogenous opioid dysfunction
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Authors: Bruehl, S., Burns, J. W., Chung, O. Y., & Chont, M.
Affiliations: Vanderbilt University (US)
Rosalind Franklin University of Medicine and Science (US)
Corresponding author: Bruehl, Stephen
ORCID: Bruehl, Stephen
Burns, John W.
Venue: Neuroscience & Biobehavioral Reviews
Publisher: Elsevier BV
Published: 2009-03
Volume: 33
Issue: 3
Pages: 475-491
ISSN: 0149-7634 (ISSN-L)
DOI: 10.1016/j.neubiorev.2008.12.003
PMC: PMC2756489
OpenAlex: W2010965582
Cited by: 88
References: 154
Citations by year: 2026: 1 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 8 · 2016: 4 · 2015: 6 · 2014: 6 · 2013: 13 · 2012: 8
FWCI: 3.61
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Neuroscience & Biobehavioral Reviews (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R01MH071260)
National Institute of Neurological Disorders and Stroke (R01NS038145, R01NS046694, R01NS050578)
National Center for Research Resources (M01RR000095, RR00095)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD015052, P30 HD-15052)
Topics: Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: anger-out, endogenous opioids, pain modulation, neural circuits, rostral anterior cingulate cortex, orbitofrontal cortex, anterior insula, amygdala, periaqueductal gray, gender differences, genetic factors, analgesia
MeSH terms: Analgesics, Opioid, Anger, Brain, Brain Mapping, Humans, Magnetic Resonance Imaging, Neural Pathways, Pain, Sex Characteristics, Pain Threshold, Opioid Peptides, Expressed Emotion, Positron-Emission Tomography

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Pain-related effects of trait anger expression: Neural substrates and the role of endogenous opioid mechanisms

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