People With Fibromyalgia Experience Harmful Cycle of Pain and Anger

New research supports the theory that people with fibromyalgia may experience a cycle involving dysfunctional metacognitions, anger rumination, state anger, and pain intensity.¹

“According to the Self-Regulatory Executive Function (S-REF) model of emotional disorders, individuals’ beliefs about their thinking processes and coping strategies, referred to as “metacognitions”, play a key role in activating and maintaining negative emotions such as anger. The S-REF model proposes that, under conditions of stress or threat, dysfunctional metacognitions can trigger maladaptive coping strategies, such as rumination (i.e., a repetitive and passive focus on symptoms of distress and the possible causes and consequences of those symptoms), that sustain emotional disturbances and impair effective emotion regulation,” Michael Tenti, ISAL Foundation, Institute for Research on Pain, Rimini, and Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy, and colleagues wrote.¹

Tenti and colleagues evaluated 446 participants who self-reported having a diagnosis of fibromyalgia confirmed by a rheumatologist or pain specialist. Participants completed self-report measures of metacognitions, anger rumination, state anger, and pain intensity. The investigators performed serial mediation analysis using Hayes’ PROCESS macro. They found that pain intensity exerted a significant positive effect on negative beliefs about worry (β = 0.09; P <.05), need to control thoughts (β = 0.09; P <.05), and cognitive self-consciousness (β = 0.12; P <.05), but not on anger rumination. The direct effect of pain intensity on state anger remained significant even after controlling for the effect of mediators, indicating partial mediation, across all serial mediation models.

“This study has important clinical implications. Although interventions for anger management in fibromyalgia should consider the influence of dysfunctional metacognitions and anger rumination, the effects of pain on metacognitions highlight the importance of validating patients’ pain experiences and their impact on metacognitions. Metacognitive therapy interventions could benefit from incorporating a psycho-educational component into the therapeutic plan. This addition would help patients understand how pain shapes metacognitive beliefs while also addressing the detrimental effects of dysfunctional metacognitions on emotional distress and pain perception,” Tenti and colleagues concluded.¹

Other recent research into pain in people with fibromyalgia has found that immersive virtual reality with multisensor biofeedback (IVR-BF) has demonstrated potential in reducing pain and improving quality of life in patients with fibromyalgia.²

Out of 50 screened patients, 20 female patients (TR, 10; WL, 10) completed the trial and analysis. Chittaro and colleagues found that the TR group had significantly lower VAS pain scores compared to those in the WL group (mean ΔVAS −26.00 [95% CI, −45.17 to −6.83]; P = .011) as well as significant improvements in the FIQ score (mean ΔFIQ, −17.90 [95% CI, −32.37 to −3.43]; P = .018).²

Longitudinally, participants experienced progressive improvements in VAS pain, SF-MPQ, and FIQ score, as well as physiologic improvements including heart rate variability, respiratory rate, and skin conductance. Significant improvements in VAS pain (mean ΔVAS −21.50 [95% CI, −32.18 to −10.82]; P < .001) and FIQ scores (mean ΔFIQ −20.25 [95% CI, −27.65 to −12.85]; P < .001) were observed after 5 sessions, though VAS scores returned to baseline by day 15. FIQ improvement was partially sustained (mean ΔFIQ −13.75 [95% CI, −23.09 to −4.41]; P = .003), and significant reductions were seen across all SF-MPQ domains, including sensory, affective, total, and PPI scores.²

REFERENCES

1. Tenti M, Varallo G, Cilenti F, Raffaeli W, Scorza M, Rubichi S, Pietrabissa G, Castelnuovo G, Gremigni P, Casu G. Pain, Anger, and Rumination in Fibromyalgia: A Vicious Cycle? J. Clin Med. 2025; 14(11):3662. https://doi.org/10.3390/jcm14113662

2. Chittaro L, Longhino S, Serafini M, Cacciopo S, Quartuccio L. Efficacy of Immersive Virtual Reality Combined With Multisensor Biofeedback on Chronic Pain in Fibromyalgia: A Pilot Randomized Controlled Trial. ACR Open Rheumatol. 2025; 7(5): e70048