Chronic pain is a multifactorial phenomenon in which emotional dysregulation—particularly aggression and hostility—may substantially influence pain intensity, chronification, and treatment outcomes. Despite growing evidence on the role of anger- and hostility-related mechanisms in pain sensitization, little is known about how different forms of aggression and hostility vary across distinct types of chronic pain conditions.

Objective. To examine the nature and severity of specific emotional-behavioral manifestations of aggression and hostility in patients with chronic pain for developing personalized painmanagement strategies

A total of 302 patients aged 18 to 70 years with chronic pain were assessed. All participants were assigned to five groups: PPP-1 — primary psychogenic pain; PPP-2 — psychophysiological pain; PPP-3 — mixed psychogenic and psychophysiological pain; SMP — secondary mixed pain; SOP — secondary organic pain. Aggression and hostility were evaluated using the Buss–Durkee Hostility Inventory.

Levels and structural patterns of aggression differed significantly across pain types. The highest scores of physical, verbal, and indirect aggression—as well as the strongest intercorrelations between aggression components—were observed in PPP-3 group. SMP group showed predominant irritability, suspiciousness, and guilt, forming a profile of "internalized aggression". Patients in PPP-1 and PPP-2 groups showed moderate aggression but pronounced self-directed hostility and inverse associations between open aggression and guilt. SOP group demonstrated the lowest overall aggression levels.

The type of chronic pain determines not only the severity but also the structure of aggressive and hostile behaviour, enabling a personalised approach to chronic pain management.