Abstract
Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.
Highlights
There is controversy on the conceptualization of anger [1]
The 13 selected studies include a total of 1511 participants, of which 902 are women with Fibromyalgia Syndrome (FMS) and 595 women belong to the control groups: 151 women with another chronic pain disorder: 71 rheumatoid arthritis (RA) patients, 50 chronic low back pain patients, 30 osteoporosis and/or osteoarthritis patients and 444 healthy women
Anger-in tends to be higher in FMS patients compared to healthy participants and RA patients
Summary
There exists a theoretical mismatch about the nature and definition of anger, its complex and dynamic conceptualization is recognized [2,3,4] In this sense, anger is considered one of the basic emotions together with fear, disgust, sadness, happiness, and surprise [1,4,5]. Anger is mainly expressed in two basic dimensions: anger towards others or outside ( called anger-out), and anger towards oneself or within (which is known as anger-in, anger turned inward, or unexpressed anger). These two basic dimensions have been deeply studied in relation to anger management (i.e., as anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical forms)) [7], and the sensitivity to both, acute and chronic pain [8]
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