Emotion Regulation in Chronic Pain Is Impaired When Pain Is High: Results From a Large Ambulatory Assessment Study

BACKGROUND: Emotion regulation (ER) is considered a transdiagnostic mechanism underlying chronic pain (CP) and depression in theoretical models such as the Örebro framework. Yet most work has focused on between-person differences rather than within-person dynamics. METHODS: This study examined whether individuals with CP show lower ER success than those without CP (NCP), whether ER or pain regulation (PR) success varies with pain experience and negative emotions at within- and between-person levels, and whether pain duration exacerbates these effects via reduced self-efficacy. Participants included a CP group (n = 176) and an NCP group (n = 161) who completed baseline assessments and a 2-week ambulatory assessment (AA) with five daily surveys. RESULTS: The CP group had significantly lower ER success than the NCP group (moderate effect: d = -0.48). Within the CP group, ER success decreased with higher-than-usual pain experience (large within-person effect: d = -0.72) and higher overall pain experience (moderate between-person effect: d = -0.55). Similarly, higher-than-usual negative emotions (moderate within-person effect: d = -0.43) and higher overall negative emotions (small between-person effect: d = -0.36) were linked to lower PR success. Pain duration did not moderate the relationship between pain experience and ER success. CONCLUSION: Findings align with the Örebro model, suggesting that pain flare-ups and negative mood strain the ER system and contribute to ER difficulties in CP, though long-term processes were not captured by pain duration or self-efficacy. SIGNIFICANCE STATEMENT: By zooming in on within-person dynamics, this study adds to growing research on ER difficulties as a transdiagnostic factor underlying chronic pain and co-occurring emotional problems. Clinically, our findings highlight the potential of just-in-time interventions integrated with ER-focused pain management, offering support at moments of greatest need.