Anger may take forms. A patient may be angry with the causal factor of their pain, which may have occurred in work or as the result of an accident. The patient may direct their anger towards the clinicians for being unable to successfully diagnose their symptoms or adequately treat them. Loss of a job or litigation may direct anger towards their employer or the legal system. Clinicians also become angry and frustrated with patients for failure to respond to treatment, take the prescribed medication or perform a given exercise programme. This can cause the clinicians to lose patience and sympathy leading to a breakdown in communication.

Without a feeling of mutual trust and cooperation between the patient and clinician the feeling of anger and hostility may lead to failed treatment which in turn fuels the feeling of anger which becomes a rut of failure and frustration.