APS Press Room
News Highlights from The Journal of Pain • November 2005
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
Does Anger Management Ability Influence Pain Response?
“Anger Management Style and Associations with Self Efficacy and Pain in Male Veterans”
Authors: Elizabeth R. Lombardo, Gabriel Tan, Mark P. Jensen and Karen O. Anderson
Affiliations: Dallas Mind Body Medicine, Baylor College of Medicine, VA Medical Center (Houston), University of Washington Department of Rehabilitation Medicine and University of Texas MD Anderson Cancer Center
While depression and anxiety in chronic pain patients has been well studied, there hasn’t been much research devoted to anger or anger management styles in this population. Some preliminary evidence, however, does suggest that people with chronic pain are at increased risk for experiencing anger, and that anger may play an important role in adjustment to chronic pain.
Results of this study of 564 veterans with chronic pain showed a significant positive correlation between a maladaptive anger management style and pain severity, and a significant negative correlation between maladaptive anger management and self-efficacy for pain management. This finding is consistent with previous research showing the outward expression of anger was associated with less favorable adjustment and treatment outcomes in patients with chronic pain.
From a clinical perspective, these findings, according to the authors, stress the importance of assessing anger coping style and self efficacy along with other common psychological variables, such as depression. Patients with chronic pain and maladaptive anger management may benefit from therapies aimed at helping them better manage and control anger to minimize its negative impact on pain relief.
Older Antidepressants Prove More Effective for Pain Relief
“Treatment Response in Antidepressant-Naïve Postherpetic Neuralgia Patients”
Authors: Michael C. Rowbotham, Lori A. Reisner, Pamela S. Davies and Howard L. Fields
Affiliations: UCSF Pain Clinical Research Center, University of California San Francisco
Patients with herpes who experience chronic nerve pain often respond well to tricyclic antidepressant (TCA) medications for pain relief. However, in many cases, most experience bothersome side effects, such as dry mouth, constipation, cognitive impairment, sedation and sexual dysfunction. Thus, newer SSRI antidepressants are preferred because they are safer and have fewer compliance-limiting side effects. But most trials on the pain relieving effect of SSRIs have focused on peripheral neuropathy.
In this study, 47 patients with postherpetic neuralgia who had never had adequate treatment with any antidepressant were randomized in a comparative trial of the TCA medications desipramine and amitriptyline and the SRRI fluoxetine. Results showed that all three drugs reduced PHN pain, but the greatest reduction in pain intensity was achieved with desipramine followed by amitriptyline.
Why are TCAs more effective than SSRIs for PHN pain relief? The authors reported that the superiority of TCAs for pain relief may be attributed to their potency as nerve-blocking sodium channel blockers, unlike SSRIs. They further concluded that since desipramine and amitriptyline are recommended as the first choice for relief of postherpetic neuralgia, clinicians should select the drugs most likely to be tolerated and slowly titrate them to optimal doses.