The effect of anger expression and perceived injustice on the formation of a beneficial therapeutic alliance in chronic pain management: A systematic review

Aims: The negative role of anger expression in chronic pain has been described. However, there is a poor understanding of the impact of anger and perceived injustice in the therapeutic alliance in this setting. The aim was to review the current literature examining anger and perceived injustice and its impact on the therapeutic alliance in the context of chronic pain. Methods: In July 2020 a search was carried out of electronic databases [Academic Search Complete, Allied and Complementary Medicine Database (AMED), Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus]. Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Results: The initial search yielded 255 results, and after duplicates were removed and inclusion and exclusion criteria applied, the final result was three papers to be reviewed. In total 225 patients were analyzed. Of the papers reviewed, all showed a negative correlation between perceived injustice and patient rating of the therapeutic alliance. Anger expression is the mediator of the proposed perceived injustice and therapeutic alliance relationship. Conclusion: The review addresses the potential role of anger expression in the modulation of the therapeutic alliance. The assessment of anger expression in chronic pain patients may be beneficial. Clinicians should be aware of its implications on the therapeutic alliance. The review highlights the need for further research which could lead to potential therapeutic interventions for such patient groups.