An expressive style of anger regulation (anger-out) is related to increased sensitivity to acute and chronic pain. Based on the role of endogenous opioids in modulation of pain, stress responsiveness, and emotional state, it was hypothesized that anger-out may exert its effects on chronic and acute pain via dysfunction in endogenous opioid systems. Preliminary data support this hypothesis with regard to dispositional anger-out. However, recent finding indicate that behavioral anger expression when anger is aroused may be analgesic in high anger-outs, suggesting that examination of Trait X State interactions could be crucial for understanding mediators of anger-out's health effects. The role of opioids in expression of these interactions is unknown.
The specific aims of the proposed study are: 1) determine whether behavioral anger expression in high anger-outs triggers opioid-mediated analgesia, and 2) determine the relationships between opioid- related effects of anger-out, in vivo behavioral anger expression, and daily chronic pain variables. Exploration of the clinically important phenomenon of anger expression as it impacts on endogenous opioid pain regulatory system function will improve understanding of the psychobiological relationships that may contribute to both acute and chronic pain responsiveness. One hundred forty subjects with chronic low back pain and 80 pain-free healthy subjects will participate in two laboratory sessions, once under opioid blockade with naloxone and once under placebo. Subjects will undergo either an anger recall interview to elicit anger arousal and behavioral anger expression, or a control non anger-arousing interview. Next, subjects will undergo acute finger pressure pain and ischemic pain stimuli. Subjects will also complete a daily electronic pain and behavioral anger expression diary between laboratory sessions. Results will reveal whether verbal anger expression when anger is aroused triggers opioid analgesia in high anger-out individuals. If the known positive relationship between chronic pain intensity and anger-out is mediated by absolute opioid dysfunction, statistical control of opioid blockade responses to acute pain (index of opioid analgesic function) should eliminate this relationship. However, if the apparent opioid dysfunction in high anger-outs is ameliorated by behavioral anger expression in the lab, the effects of opioid triggering on chronic pain in response to in vivo behavioral anger expression should be evident in intensive diary data.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
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Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
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Porter, Linda L
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Vanderbilt University Medical Center
Schools of Medicine
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Burns, John W; Bruehl, Stephen; Chont, Melissa (2014) Anger regulation style, anger arousal and acute pain sensitivity: evidence for an endogenous opioid ""triggering"" model. J Behav Med 37:642-53
Bruehl, Stephen; Denton, Jerod S; Lonergan, Daniel et al. (2013) Associations between KCNJ6 (GIRK2) gene polymorphisms and pain-related phenotypes. Pain 154:2853-9
Bruehl, S; Burns, J W; Chung, O Y et al. (2012) What do plasma beta-endorphin levels reveal about endogenous opioid analgesic function? Eur J Pain 16:370-80
Bruehl, Stephen; Liu, Xiaoxia; Burns, John W et al. (2012) Associations between daily chronic pain intensity, daily anger expression, and trait anger expressiveness: an ecological momentary assessment study. Pain 153:2352-8
Burns, John W; Quartana, Phillip; Bruehl, Stephen (2011) Anger suppression and subsequent pain behaviors among chronic low back pain patients: moderating effects of anger regulation style. Ann Behav Med 42:42-54
Bruehl, Stephen; Burns, John W; Chung, Ok Yung et al. (2011) Interacting effects of trait anger and acute anger arousal on pain: the role of endogenous opioids. Psychosom Med 73:612-9
Bruehl, Stephen; Chung, Ok Y; Chont, Melissa (2010) Chronic pain-related changes in endogenous opioid analgesia: a case report. Pain 148:167-71
Burns, John W; Bruehl, Stephen; Chung, Ok Y et al. (2009) Endogenous opioids may buffer effects of anger arousal on sensitivity to subsequent pain. Pain 146:276-82
Bruehl, Stephen; Burns, John W; Chung, Ok Y et al. (2009) Pain-related effects of trait anger expression: neural substrates and the role of endogenous opioid mechanisms. Neurosci Biobehav Rev 33:475-91
Burns, John W; Quartana, Phillip J; Bruehl, Stephen (2009) 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. Psychosom Med 71:454-62

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