Pain, Anger, and Rumination in Fibromyalgia: A Vicious Cycle?

Background/Objectives: Fibromyalgia is a debilitating syndrome characterized by persistent pain. Emerging evidence highlights the role of emotional and cognitive processes in modulating pain experience. Anger, for example, can influence pain and patients' adjustment to the disease. Studies showed that metacognitions and anger rumination can worsen state anger, thereby increasing perceived pain intensity. The present study aims to investigate the presence of a relationship between pain, dysfunctional metacognitions, anger rumination, and state anger. Methods: The study included 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 serial mediation analysis was performed using Hayes' PROCESS macro (Model 6). Results: Pain intensity showed a significant positive effect on negative beliefs about worry (β = 0.09; p < 0.05), need to control thoughts (β = 0.09; p < 0.05), and cognitive self-consciousness (β = 0.12; p < 0.05), but not on anger rumination. Across all serial mediation models, the direct effect of pain intensity on state anger remained significant even after controlling for the effect of mediators, indicating partial mediation. Conclusions: This study suggests a vicious cycle involving dysfunctional metacognitions, anger rumination, state anger, and pain intensity. Our findings also indicate a potential influence of pain on metacognitions and suggest a direct association between pain intensity and state anger. Interventions for anger management in fibromyalgia should consider dysfunctional metacognitions and anger rumination.