The Relationship between Anger Regulation, Mood, Pain, and Pain-Related Disability in Women Treated for Breast Cancer

Abstract

Objective Anger, depressive symptoms, and anxiety are known reactions to cancer and suggested to modulate pain experience. We examined the association between anger regulation, mood, and pain in 952 breast cancer patients followed for 3 years.

Methods Preoperatively, the patients completed questionnaires about depressive symptoms (BDI), state anxiety (STAI), anger regulation (STAXI‐2), and pains in the surgical and other areas. Experimental pain sensitivity was tested. In the follow‐up, BDI and STAI were assessed at 1 and at 6 months and at 1, 2, and 3 years after surgery. Pain in the surgical area was evaluated during the first 7 days and at 1 and 3 years after surgery. Pain‐related disability was assessed at 3 years after surgery. Latent profile analyses were performed to identify mood profiles, and regression analyses to find independent predictors for mood and pain variables.

Results Anger inhibition and pain had associations with ongoing depressive symptoms and anxiety. Pain‐related disability was associated with high anxiety at a hazard ratio (HR) of 2.24 (95% CI, 1.17‐4.27), with older age (HR 1.07, 95% CI, 1.01‐1.13), and with pain in the surgical area (HR 3.04, 95% CI, 2.41‐3.85), but not with anger variables. Any relationship between anger regulation and pain intensity disappeared after controlling for age and mood.

Conclusions Different forms of pain are important to recognize and treat to support breast cancer patients' psychological well‐being. Anger inhibition could be a target for psychotherapeutic intervention, to help with ongoing mood symptoms. The relationship between anger regulation and pain is not straightforward.