In a manner characterized by intense suffering or agony; with great distress or pain.
From 'anguishous' plus '-ly,' the standard English adverb suffix. This creates an adverbial form describing how an action is performed or how something exists in a state of suffering.
This adverb shows how English builds complexity through suffixes—you start with a Latin root (anguis/angustia), add '-ous' for the adjective, then '-ly' for the adverb, creating a chain of meaning!
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