{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T05:21:04Z","timestamp":1788067264906,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ricerca Corrente"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2019 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\u2019 PROCESS macro (Model 6). Results: Pain intensity showed a significant positive effect on negative beliefs about worry (\u03b2 = 0.09; p &lt; 0.05), need to control thoughts (\u03b2 = 0.09; p &lt; 0.05), and cognitive self-consciousness (\u03b2 = 0.12; p &lt; 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.<\/jats:p>","DOI":"10.3390\/jcm14113662","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T06:35:09Z","timestamp":1747982109000},"page":"3662","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pain, Anger, and Rumination in Fibromyalgia: A Vicious Cycle?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-018X","authenticated-orcid":false,"given":"Michael","family":"Tenti","sequence":"first","affiliation":[{"name":"ISAL Foundation, Institute for Research on Pain, 47921 Rimini, Italy"},{"name":"Studi Cognitivi, Cognitive Psychotherapy School and Research Center, 20121 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Varallo","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Cilenti","sequence":"additional","affiliation":[{"name":"ISAL Foundation, Institute for Research on Pain, 47921 Rimini, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0240-8993","authenticated-orcid":false,"given":"William","family":"Raffaeli","sequence":"additional","affiliation":[{"name":"ISAL Foundation, Institute for Research on Pain, 47921 Rimini, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7031-0547","authenticated-orcid":false,"given":"Maristella","family":"Scorza","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Rubichi","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Pietrabissa","sequence":"additional","affiliation":[{"name":"Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20123 Milan, Italy"},{"name":"Department of Psychology, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2633-9822","authenticated-orcid":false,"given":"Gianluca","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20123 Milan, Italy"},{"name":"Department of Psychology, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1527-2434","authenticated-orcid":false,"given":"Paola","family":"Gremigni","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Bologna, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5441-3044","authenticated-orcid":false,"given":"Giulia","family":"Casu","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Bologna, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1097\/j.pain.0000000000000160","article-title":"A Classification of Chronic Pain for ICD-11","volume":"156","author":"Treede","year":"2015","journal-title":"Pain"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Goldberg, D.S., and McGee, S.J. 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