Being angry can worsen chronic pain

Anger is an emotional response to things that don’t go the way we want them to. Anger results from the experience of feeling “wronged” in some way. Depending on the situation, anger is a healthy and appropriate emotional reaction. Problems with anger usually occur in how this powerful feeling is expressed. Anger can be expressed along a broad spectrum, from suppressing it (not expressing it outwardly) or keeping it inside to the point where you may not even be aware that you are angry, to exploding, such as with screaming, verbal abuse, or even physical violence. Anger and the resentment it can fuel can cause significant stress and high blood pressure, along with increased muscle tension and increased pain.

When you are in pain, you may unconsciously direct anger to the site of the physical pain (“My back is killing me!”). Anger might also be directed at yourself because you are unable to do the things you would like to do and/or were able to do previously. It may also be directed at others close to you, like family members and friends, for not understanding, not being supportive enough, or simply because they are in the wrong place at the wrong time. It is also common to be angry with the health care system, specifically the doctors who were unable to help you or who prescribed the medications that you became dependent on, or the insurance company that won’t pay for the next procedure, let you see the next specialist, or pay for your disability. It is common to direct your anger at something or someone when you’re really angry at something else. For example, you are angry because your back hurts, but you shout at your kids or kick the dog. This is referred to as displaced anger. Frequently, the more anger you have, the more it contributes to your level of pain, and the more out of emotional balance you are.

In most circumstances, anger is really a secondary emotion. It often forms immediately and automatically (this happens unconsciously, so there may be no awareness of it) in response to a situation that brings up feelings of hurt, fear, and/or inadequacy. Hurt and fear are the primary emotions that anger covers up. When most people experience these primary emotions, they feel vulnerable and their energy and attention are focused internally. This inward focus on one’s own vulnerabilities is extremely uncomfortable, especially for individuals who are used to focusing on other people and things outside themselves. Anger serves several defensive purposes. It works as a shield that deflects uncomfortable primary emotions so they can be avoided or kept at a distance. Anger provides a sense of power and control, and directs focus outward to identifiable, external scapegoats. It is almost always easier and more comfortable to focus on the actions of others than it is to focus on yourself.

What can you do about anger? First and foremost, awareness that you are angry is necessary in order to make a conscious decision as to what to do about it. It is helpful to ascertain what you are really angry about—the true reason that you are angry. Knowing the source of the anger and looking beneath the apparent reason (“He’s just a jerk”) to a deeper level (“My feelings were hurt because he disappointed me”) is valuable in examining your emotional reaction. The next steps in dealing with anger are identifying your wants and needs related to what’s happening; selecting the solutions that are the best fit from the available options; and then taking action to implement those solutions. This solution-oriented process provides a direct route to finding balance and, consequently, turning down the volume on your pain.

Looking more deeply at anger:

Describe the two most recent instances when you were angry.
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Describe what happened to your pain level during these situations.
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Now try to identify the underlying emotions in these situations that your anger may have been keeping under cover, such as hurt, fear, or inadequacy.
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Be aware that you almost always play a part in the problems you experience. Identify how you may have contributed to the situation(s) that you were angry about.
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Resentment is related to anger in that it is a negative feeling or ill will directed at someone or something experienced as wrong, unjust, insulting, or disrespectful. Anger is about the present, whereas resentment relates to the past. It is a re-experiencing of past events and the old feelings of anger connected to them. Resentment is created when we get angry at a person, institution, or situation, and hold onto that anger.

People can hold onto resentment for many years, refusing to let go, forgive, or forget, carrying their resentment wherever they go. Like an extra suitcase, it is baggage that weighs them down and requires attention and energy. Over time the person, place, thing, or event that caused the original anger and led to resentment may be forgotten, while the resentment remains like smoldering embers that are left after the flames of a fire have died down. The fire no longer rages, but the embers remain hot and capable of causing more fires in the future unless they are extinguished. As long as these embers continue to burn, they create negative distractions that take time, attention, and energy away from your pain recovery. As long as you are focused on the people and situations you are angry at and resentful toward, you are out of balance emotionally and typically feel more pain.

The continuous mental and emotional reenactment of past events that occurs with resentment reinforces feelings of being victimized. Feeling that you have been “wronged” makes you feel like a victim. This makes pain recovery more difficult because such perceptions interfere with the ability to take responsibility for your own choices and actions. The stronger the resentment is, the more time you spend thinking about it and caught up in the anger connected to it. This is a form of mental, emotional, and spiritual bondage. Ultimately, the person holding the resentment is the one who suffers most. After all, you can’t change the past. So all you can do is shift your focus away from the past and toward being as successful as you can in the here and now.

The following are some techniques you can apply to deal with anger and resentment more effectively and regain emotional balance:

  • Treat other people with fairness and compassion, even when you feel angry at or have resentment toward them. Notice what happens when you change how you act toward them in positive ways. They may change how they act with you.
  • Practice expressing your anger and/or resentment in healthier, recovery-oriented ways: Talk about these feelings with safe, appropriate people; talk about them without yelling, screaming, threatening, or acting out; write about them; let go of them physically by working out, taking a run, going for a hike, or playing sports.
  • Resist the urge to be a channel for the anger or resentment of others. The anger and resentment of others can be seductive—it can have an almost magnetic pull. Don’t buy into it; resist the urge to join in their misery.
  • Accept that the past is the past. It is as good as it’s ever going to get! Give yourself reminders of this whenever you need to.
  • Keep in mind that while anger and resentment are normal, natural emotions, you are always responsible for your actions. No one can “make” you do anything. You choose how you act and the choice you make is your responsibility. Acting out inappropriately can cause regret and further add to your anger and resentment.
  • Stop expecting to be perfect.
  • Notice what happens to your pain level whenever you apply these suggestions.

Letting go of resentment:

List the sources of your resentment.
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Write a few ways to decrease their hold on you.
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This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP).