The Relationship Between Perceived Injustice And Pain-related Outcomes

In the context of debilitating injury,perceived injustice has been conceptualized as an appraisal process characterized by a tendency to construe injury or illness as a violation of justice principles,to view one’s losses as severe and irreparable and to attribute blame to others for one’s suffering(M.J.L.Sullivan et al.,2008).A growing body of literature shows that justice-related appraisals are significant determinants of adverse pain-related outcomes and prolonged trajectories of recovery.Previous studies have shown that,although cognitive-behavioral models of emotional disturbances have posited that experiences of perceived injustice typically result in anger,researchers have also documented associations between injustice experiences and other negative emotional reactions.In addition,the Injustice Experience Questionnaire(IEQ)has not been validated in Chinese chronic pain samples.To date,research has focused on the independent contributions of pain acceptance and pain catastrophizing on associations between perceived injustice and pain-related outcomes.A combined conceptual model that addresses the interrelationships between these variables is currently lacking.Therefore,the following three studies were utilized to fill in the gaps of existing research.To assess relative strengths of relation between perceived injustice and anger versus other negative emotional reactions in samples with ongoing pain and evaluate overall associations between injustice experiences and other pain-related outcomes,Study 1 performed a meta-analysis of past research on the relationship between perceived injustice and pain-related variables.44 Studies based on 42 samples(N =8369)that completed a validated version of the Injustice Experience Questionnaire(IEQ)and measures of emotional distress,impairment,pain severity,compensation status and/or return-to-work status were included for analyses.The overall perceived injustice-emotional distress association was moderated by nature of distress.Contrary to cognitive-behavioral account premises,perceived injustice had more pronounced associations with pain catastrophizing,post-traumatic stress symptoms and anxiety while relations with anger were relatively attenuated.Other analyses confirmed significant overall associations between injustice experiences and impairment,pain severity,compensation status and return-to-work though effect size magnitudes were highly variable.Association between perceived injustice and pain severity was also moderated by Country(Canada versus U.S.).Study 2 was designed to examine the psychometric properties of the Chinese version Injustice Experience Questionnaire(IEQ)and test the best IEQ factor model suitable for Chinese clinical samples.317 mainland Chinese adults with chronic pain(197 women,120 men)completed self-report measures of perceived injustice,fear of moment,pain catastrophizing,pain acceptance,pain vigilance,pain self-efficacy,psychological resilience,cognitive coping and pain-related dysfunction(pain severity,pain interference,affective distress,depression).Confirmatory factor analysis results showed that the Chinese version of IEQ had good reliability and validity and best fit with the two-factor structure proposed by M.J.L.Sullivan et al.(2008).The correlations between perceived injustice and pain-related variables in a Chinese clinical setting were consistent with the effect sizes of study 1.To explore the mechanism of perceived injustice on pain-related outcomes(pain severity,pain interference and depression)in Chinese context,Study 3 was conducted to examine the multiple mediating roles of pain acceptance and pain catastrophizing between perceived injustice and pain-related variables in Chinese clinical chronic pain patients.423 mainland Chinese adults with chronic pain(252 women,171men)completed self-report measures of perceived injustice,pain catastrophizing,pain acceptance and pain-related dysfunction(pain intensity,pain interference,depression).Results of multiple mediation analyses revealed that the mediating effect of pain acceptance was significant only in the relationship between perceived injustice and pain interference.Both the mediating effect of pain catastrophizing and the chain mediating effect of pain acceptance and pain catastrophizing were significant between perceived injustice and pain-related outcomes(pain intensity,pain interference and depression).In sum,the three studies were closely related and logical,and systematically explored the relationship between perceived injustice and pain-related outcomes from different perspectives and using different methods.Results helped us to better understand the nature of the relationship between perceived injustice and pain-related variables,the use and validation of perceived injustice measures,and the mechanisms by which these connections work.At the same time,it also laid a good foundation and provided theoretical support for the future research in related fields.