Living With Chronic Pain

Anger and Pain

The last few posts have discussed where pain is located in the brain and how close it is to other inputs such as touch, sensation, temperature regulation, and spatial awareness. That’s why we can “trick” or distract the brain and lessen pain. Studies have also shown physical and emotional pain share similar pathways.

The brain is connected to the rest of the body through a massive web of neural signals in the brain stem and spinal cord. The circulatory and lymphatic system send neurotransmitters in the form of hormones and immune cells that activate receptors in the brain which then feeds back and modulates the responses between the brain and body. This is how every cell in the body can be sensed and felt.

When we get hurt physically, we know immediately where the trauma is occurring- back, toe, heart, stomach, etc. Even though most of the processing occurs in the head. This is because every interaction between the brain and body is tagged with a locator defining exactly where it came from. The tags get more specific as it goes through the spinal cord with more and more specific tagging as it ascends through the brain stem and thalamus. Each adds more identifying information and complexity until it becomes a vivid image in the insula, parietal and motor cortexes. It all happens in a fraction of a second.

The anterior insula and anterior cingulate cortex get activated by both emotional and physical stressors. Break up with a spouse? Injure your knee? The same areas light up on functional MRIs. Pain networks, regardless of the source, use the same pathways. They are interconnected. That’s how micro facial expressions work. No matter how hard we try, if you know what to look for, these micro muscular activations give us away- contempt, anger, fear, pain. . .It’s all in our faces. This is because the anterior cingulate, where the process of turning an emotional expression into an action occurs, sits next to the pre-motor cortex, which then activates the motor cortex above it. Signals are then sent to specific muscles that define an expression. It happens so fast we don’t even know we’re doing it.

Emotional pain may also reside in those places where we never followed through. When you stub your toe but hold in the scream. This then causes your neck, throat and jaw to tighten up, becoming a “pain in the neck.” Or “a pain in the butt” when there’s the urge to kick something. Rage and hatred go deep in the gut, “I’m so mad I could throw up,” or I miss them so much “my heart is breaking.”

Pain is always both physical and emotional. That never means it isn’t real.

One emotion common in chronic pain sufferers is anger, at themselves, loved ones, healthcare providers. In one study, 70% admitted feeling angry. It’s a primal emotion that comes when we perceive a threat to our well-being. Activity in the amygdala and hypothalamus automatically cause a chain reaction to help us survive. So, it’s easy to understand why it kicks in when the ultimate threat to our survival occurs -pain. But it also worsens pain by creating tension, spasms and releasing adrenaline, cortisol, C-reactive proteins- all leading to a fight or flight state.

Studies have shown that persistent thoughts of anger worsen pain and impairs function. Over time it actually trains the brain to increase the frequency with which anger and pain are felt because both activate the same neuronal pathways in the brain. Anger in essence becomes a carrier for pain. Neuroimaging shows overlapping neural circuits that regulate both pain and anger in the following regions:

  • Rostral anterior cingulate cortex
  • Orbitalfrontal Cortex
  • Anterior insula
  • Amygdala
  • Periaquaductal gray

Anger amplifies pain

  • When we’re angry we release adrenaline which makes the nervous system hyperactive by changing the hypothalami+pituitary-adrenal axis. This then releases a whole host of other changes that increase blood pressure, heart rate and pain simultaneously.
  • It prolongs exposure to cortisol and keeps us in a fight or flight mode long term. Shredding muscles, shutting down our gut and causing persistent feelings of anxiety and stress.
  • Staying angry is like having a wound that’s never cleaned, bandaged or healed. It festers and ultimately spreads. Suppressed anger affects both our physical and emotional well-being.

Stopping this maladaptive cycle is imperative.

Anger is a normal emotion. It’s what we do with it that matters. Turning it inward and blaming ourselves because we aren’t living up to expectations, able to contribute as we want or believe we somehow cause the pain, isn’t healthy. Nor is displacing it by blaming loved ones, friends, co-workers, strangers, God.

We need to find better ways to process how our lives have changed and reconnect with a vision of the path that brings us health and happiness. Chronic pain doesn’t make us weak or incapable. Finding better ways to manage our lives so we can learn to live with it is the key. Anger isn’t the answer. Some may feel empowered by it, others fueled by the feeling, but studies have shown the more anger we feel the worse our pain.

Years ago, it was a popular notion that all pain is due to unreleased anger. How easy would that be? Kick a ball, hit a punching bag, yell till you’re blue in the face and the pain miraculously improves? Hearing that made me want to spend a minute with the author. Yes, it can contribute and even exacerbate pain but those of us suffering from chronic pain didn’t get here because we are angry. Implying otherwise is demeaning and wrong. Instead of stuffing it inside or stewing on what we can’t do, or how others are treating us, learning to express ourselves safely is the key. Then we become the rulers of our own fate.

Next week I’ll discuss tips to do just that.

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