Emerging evidence suggests that perceived injustice is a risk factor for adverse outcomes associated with chronic pain. To date, however, the processes by which perceived injustice impacts on pain outcomes remain speculative. Evidence from several lines of research suggests that anger may mediate the relationship between injustice and pain outcomes. However, this relationship has not been empirically tested in patients with chronic pain. Thus, the purpose of this study was to examine whether anger mediates the relationships between perceived injustice and pain intensity, depressive symptoms, and self-reported disability. One hundred and seventy-three individuals with chronic musculoskeletal pain completed self-report measures of perceived injustice, anger, pain intensity, depressive symptoms, and disability. Consistent with previous research, high scores on a measure of perceived injustice were associated with greater pain, more severe depressive symptoms, and more pronounced disability. Hierarchical regression analyses indicated that anger variables completely mediated the relationship between perceived injustice and pain intensity, and partially mediated the relationship between perceived injustice and depressive symptoms. Anger did not mediate the relationship between perceived injustice and self-reported disability. The Discussion addresses the theoretical and clinical implications of the findings.
Our results indicate that individuals with high JWB may show particularly adverse reactions in response to justice violations in the context of acute pain experience.
Purpose: The aim of the present study was to investigate the factors that influence the change in pain catastrophizing during the course of a physical therapy intervention for musculoskeletal injury. Methods: 187 clients enrolled in a 7-week physical therapy intervention were divided into four mutually exclusive groups on the basis of a pre-treatment assessment: (1) clients whose pretreatment catastrophizing scores and measures of mental health problems were below clinical threshold, (2) clients whose pre-treatment catastrophizing scores were above clinical threshold but who scores on measures of mental health problems were below clinical threshold, (3) clients whose pre-treatment catastrophizing scores were above clinical threshold and whose scores on measures of mental health problems were also above clinical threshold, and (4) clients whose pre-treatment catastrophizing scores were below clinical threshold but whose scores on measures of mental health problems were above clinical threshold. Results: The most prevalent risk profile consisted of clients with high levels of pain catastrophizing and high mental health problems (37 %), followed by the low catastrophizing and low mental health problems profile (35 %), the high catastrophizing and low mental health problems profile (16 %), and low catastrophizing and high mental health problems profile (10 %). Clients were considered nonresponders if their post-treatment catastrophizing score remained above clinical threshold following treatment. Chi square analyses revealed a significantly higher proportion of non-responders in the high catastrophizing and mental health problem group than in any other group. Conclusions: The presence of mental health symptoms markedly reduces the effectiveness of physical therapy for reducing catastrophizing scores. The 'risk value' of high catastrophizing scores thus appears to vary as a function of the presence or absence of mental health symptoms. The findings argue for the inclusion of measures of mental health problems in the routine screening of individuals treated in physical therapy.
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