Background and Purpose: Difficulties in emotional expression can contribute to somatisation and reduced quality of life in chronic pain. This pilot study aimed to explore the relationship between the bodily representations of pain and emotions, and to examine how the characteristics and difficulties of emotional expression are reflected visually.


Methods: Total of 32 patients (70% female; 30% male with mean age of 51.3 years (23-77 years; SD = 16.4) diagnosed with chronic headache (n = 20) and chronic musculoskeletal pain (n = 12) followed-up at a Chronic pain and Headache Outpatient Care, Department of Neurology, Szeged, Hungary completed psychological self-report questionnaires (Toronto Alexithymia Scale, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory) and drawing-based tests (Pain Drawing Test, Bodily Maps of Emotions, Pictorial Representation of Illness and Self Measure Drawing Test). Both qualitative and quantitative statistical analyses were applied.


Results: Qualitative results suggest that the visual representation of 'pain' shows greatest similarity to the representation of the emotion 'anger'. 'Anger' was also represented most often as an out-of-body experience compared to other emotions (n = 20; 60.6% of patients). Depicting emotions in the head region showed a significant but weak correlation with the 'pragmatic thinking' dimension of alexithymia (r = 0.35; p = 0.046). Based on the results of one-way ANOVA analysis, chronic headache patients represented 'happiness' (p = 0.02), 'sadness' (p = 0.04), 'fear' (p = 0.01) and 'anger' (p = 0.05) in larger areas within the Bodily Maps of Emotions compared to chronic musculoskeletal pain patients.


Conclusion: Our findings highlight the connection between pain and anger, as well as its potential importance in pain management. The role of emotional regulation and anger can be further explained within the Anger-Brain-Nociplastic Pain Model, with implications for multimodal pain treatment.