The role of perceived injustice in the prediction of pain and function after total knee arthroplasty

et al. 2016

The Journal of Pain

Chronic pain is prevalent in children/adolescents and contributes to high healthcare utilization. Research suggests injustice perceptions about pain are important in adult patients and a possible treatment focus. We conducted a preliminary evaluation of the psychometric properties of the Injustice Experiences Questionnaire (IEQ) and the relationship between injustice perceptions, pain, and functioning in chronic pain patients (N=139, mean age=15 years, 72% female) presenting to a pediatric pain clinic. Patients completed measures assessing pain intensity, injustice perceptions about pain, catastrophizing, overall functional disability, emotional functioning, social functioning, and school functioning. The IEQ demonstrated good reliability and validity. Higher levels of perceived injustice were associated with higher levels of pain intensity, catastrophizing, and functional disability, and with poorer emotional, social, and school functioning. Additionally, perceived injustice remained significantly associated with pain intensity, functional disability, emotional functioning, social functioning, and school functioning after accounting for relevant demographic and clinical factors. This is the first study to suggest that injustice perceptions are important in the experience of pediatric chronic pain patients.Future studies should more thoroughly examine the psychometric properties of the IEQ in children/adolescents and elucidate the causal nature of these relationships, which will inform treatment efforts to improve pediatric pain care.Perspective: This initial investigation suggests that injustice perceptions about pain can be reliably and validly measured and are tied to important clinical outcomes in children/adolescents. Future studies that replicate and extend these preliminary results are necessary to determine the extent to which injustice perceptions are an important target for intervention.

“…These findings are in line with research in adults with osteoarthritis and musculoskeletal pain resulting from an occupational or motor vehicle accident [53,66].…”

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 75%

Perceived Injustice Is Associated With Pain and Functional Outcomes in Children and Adolescents With Chronic Pain: A Preliminary Examination

Miller

Scott

et al. 2016

The Journal of Pain

“…Given the previously demonstrated associations between perceived injustice and variables associated with pain and disability (including pain catastrophizing and pain-related fear [26,38,39,41]), this finding is perhaps not surprising, as these constructs/cognitions also show association with AB (e.g., [1,18,45,56]). Although this was not directly assessed in the current study, it is important to note that previous research acknowledges some overlap between perceived injustice and pain catastrophizing [38]; however, perceived injustice has been conceptualized (and supported) as a distinct construct reflecting elements of blame and anger, which are not captured by pain catastrophizing [29,38,55]. Further, the association between anger and perceived injustice may be reflected in our exploratory findings of pictorial stimuli.…”

Section: Discussionmentioning

confidence: 78%

The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample

Ryckeghem

Scott

et al. 2016

The Journal of Pain

Self Cite

The current study examined the relationship between perceived injustice and attentional bias (AB) toward pain among individuals with chronic low back pain asked to perform and appraise the pain and difficulty of a standardized set of common physical activities. A pictorial dot-probe task assessed AB toward pain stimuli (i.e., pain faces cueing pain), after which participants performed the physical tasks. Participants also rated face stimuli in terms of pain, sadness, and anger expression. As hypothesized, perceived injustice was positively associated with AB toward pain stimuli; additionally, perceived injustice and AB were both positively associated with appraisals of pain and difficulty. Counter to expectations, AB did not mediate the relationship between perceived injustice and task appraisals, suggesting that AB is insufficient to explain this relationship. Exploratory analyses indicated that participants with higher levels of perceived injustice rated stimulus faces as sadder and angrier; no such differences emerged for pain ratings. This is the first study to examine the association between perceived injustice and AB toward pain, as well as perceived injustice and in-vivo appraisals of common physical activity. Results extend existing literature and suggest that attentional and potential interpretive bias should be considered in future research.Perspective: This article identifies significant associations between perceived injustice, biased attention to pain, and appraisals of common physical activities among individuals with chronic low back pain. These findings suggest targets for intervention as well as directions for future research regarding individuals with high perceptions of injustice related to pain.

“…Perception of injustice, defined as an appraisal reflecting the severity and irreparability of injury- or disability-related loss, blame, and unfairness, has been identified as a significant barrier to effective recovery after acute injury (4–7), and predicts poorer outcomes in both acute pain and chronic pain populations (4, 6). For example, individuals who view their pain as unjust tend to report greater pain (8, 9) and depressive symptoms (10–12) and show greater susceptibility to maladaptive pain behaviors (13, 14). Perceived injustice may bias an individual’s appraisal process to loss and blame-related cues, thus limiting their coping repertoire.…”

Section: Introductionmentioning

confidence: 99%

Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption

Sturgeon

Ziadni

Scandinavian Journal of Pain

et al. 2017

AbstractBackground and purposePrevious research has highlighted the importance of cognitive appraisal processes in determining the nature and effectiveness of coping with chronic pain. Two of the key variables implicated in appraisal of pain are catastrophizing and perceived injustice, which exacerbate the severity of pain-related distress and increase the risk of long-term disability through maladaptive behavioural responses. However, to date, the influences of these phenomena have not been examined concurrently, nor have they been related specifically to quality of life measures, such as life satisfaction.MethodsUsing data froman online survey of330 individuals with chronic pain, structural path modelling techniques were used to examine the independent effects of pain catastrophizing, perceived injustice, and average pain intensity on life satisfaction. Two potential mediators of these relationships were examined: depressive symptoms and pain-related interference.ResultsResults indicated that depressive symptoms fully mediated the relationship between pain catastrophizing and life satisfaction, and pain interference fully mediated the relationship between pain intensity and life satisfaction. Both depressive symptoms and pain interference were found to significantly mediate the relationship between perceived injustice and life satisfaction, but perceived injustice continued to demonstrate a significant and negative relationship with life satisfaction, above and beyond the other study variables.ConclusionsThe current findings highlight the distinct affective and behavioural mediators of pain and maladaptive cognitive appraisal processes in chronic pain, and highlight their importance in both perceptions of pain-related interference and longer-term quality of life.