Jerusalem, 3 December, 2025 (TPS-IL) — Chronic pain may not just be a physical condition — it’s also deeply tied to how patients process anger and perceive fairness. An Israeli-led international study found that people who feel wronged or unfairly treated by their condition are more likely to experience severe, long-lasting pain, suggesting that emotional factors could be just as important as biology in predicting outcomes.
The research team, led by Dr. Gadi Gilam, head of the translational Social, Cognitive, and Affective Neuroscience (tSCAN) lab at the Institute of Biomedical and Oral Research at Hebrew University, examined more than 700 adults living with chronic pain. Collaborators included teams from Stanford University, Boston University, and the University of Innsbruck. The findings were published in the peer-reviewed The Journal of Pain.
Using a method called latent profile analysis, the researchers identified four “anger profiles,” capturing how patients experience, express, and regulate anger, and how strongly they feel wronged by their situation. The results were striking. Participants with medium to high levels of both anger and perceived injustice — those who saw their pain as unfair or representing a personal loss — reported the worst outcomes. They experienced higher pain intensity, more widespread discomfort, and greater disability and emotional distress.
By contrast, patients who managed their anger effectively and maintained a less resentful view of their condition fared significantly better over time.
“Anger is not inherently bad,” Gilam explained. “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 study followed 242 participants for about five months, confirming that anger profiles predicted future pain outcomes even after accounting for anxiety and depression. The findings suggest that assessing anger and perceived injustice could serve as an early warning system, helping clinicians identify patients at risk for long-term, high-impact pain and design more targeted treatment plans.
“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,” Gilam said. “We currently do not have a simple pill to cure chronic pain, nor do we have strong tools to predict whose pain will persist. Integrating anger and injustice assessments into treatment could fundamentally improve outcomes.”
The research emphasizes practical interventions, including Emotional Awareness and Expression Therapy and compassion-based approaches, to help patients process anger and reframe perceptions of unfairness. Experts say this shift could transform pain care by addressing not only physical symptoms but also the emotional and psychological dimensions that keep pain alive.
For patients, understanding the role of anger and injustice in their suffering may open new paths to relief. Techniques such as Emotional Awareness and Expression Therapy (EAET), mindfulness, or cognitive-behavioral strategies can help individuals recognize when anger or a sense of injustice is intensifying their suffering. Learning to reframe pain as a neutral biological experience rather than a personal wrong may reduce its perceived intensity.
For clinicians, the findings offer a path toward more personalized, effective care. Assessing patients’ anger profiles and perceptions of injustice can help identify those at higher risk for persistent or severe pain. Treatment plans can then combine conventional approaches, such as medications and physical therapy, with emotion-focused interventions tailored to the patient’s psychological profile.
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