We all know stress can worsen pain, but new research shows that anger and a sense of injustice may be even more powerful triggers. In a study of more than 700 people living with chronic pain, researchers uncovered four distinct “anger profiles” that help explain why some patients hurt more, and longer, than others. Those who felt wronged or unfairly treated by their condition were the most likely to report severe, persistent pain months later. The findings suggest that learning to understand and manage anger could be essential to healing.

We all get angry sometimes, but for people living with chronic pain, anger may do more harm than we realize. A new study led by Dr. Gadi Gilam, head of the translational Social, Cognitive, and Affective Neuroscience (tSCAN) lab at the Institute of Biomedical and Oral Research, the Hebrew University of Jerusalem, reveals that anger, especially when coupled with a sense of injustice, can predict not only how much pain patients feel today but also how much they may continue to suffer months down the line.

The international research team, which included collaborators from Stanford University, Boston University, and the University of Innsbruck, examined more than 700 adults seeking treatment for chronic pain of various causes. Using a method called latent profile analysis, they identified four distinct “anger profiles”, each describing how people experience, express, and control anger, and how strongly they feel wronged by their situation.

The findings were striking. Patients who exhibited medium to high levels of both anger and perceived injustice, such as those who felt their pain represented unfair treatment or an irreparable loss, experienced the worst pain outcomes. They reported greater pain intensity, more widespread pain, and higher levels of disability and emotional distress. In contrast, individuals who seemed to manage their anger effectively and viewed their condition with less resentment tended to fare significantly better over time.

“Anger is not inherently bad,” explains Dr. Gilam. “It is a common daily emotional signal, and can promote personal and inter-personal well-being when regulated well. But when anger mixes with a sense of injustice, which in itself is a trigger for angry reactions, it can trap people in a cycle of emotional and physical suffering that amplifies and maintains chronic pain.”

The research followed 242 participants for about five months, confirming that the identified anger profiles predicted future pain outcomes even after accounting for anxiety and depression. The results point to the potential of using these profiles as early diagnostic markers, helping clinicians identify patients at risk for long-term, high-impact chronic pain and offering more personalized, emotion-focused treatment plans.

According to Dr. Gilam, “This study highlights that how patients feel about their pain, particularly whether they see it as unfair, may be just as important as the biological causes. We currently do not have a good enough understanding of the neurobiology underlying chronic pain. We do not have a simple pill to cure it, nor do we have strong assessment tools to predict whose pain will persist. Integrating anger and injustice assessments into chronic pain treatment could fundamentally improve outcomes.”

The study emphasizes the need for tailored interventions that address emotional regulation and perceptions of injustice, such as Emotional Awareness and Expression Therapy and compassion-based therapies. Understanding anger’s many faces may be the next step in transforming pain care, from treating symptoms to treating the person.