Perceived injustice: A risk factor for problematic pain outcomes

Department of Psychology, McGill University, Montreal, QC, Canada.
The Clinical journal of pain (Impact Factor: 2.53). 07/2012; 28(6):484-8. DOI: 10.1097/AJP.0b013e3182527d13
Source: PubMed


Emerging research suggests that perceptions of injustice after musculoskeletal injury can have a significant impact on a number of pain-related outcomes.
The purpose of this paper is to review evidence linking perceptions of injustice to adverse pain outcomes. For the purposes of this paper, perceived injustice is defined as an appraisal cognition comprising elements of the severity of loss consequent to injury ("Most people don't understand how severe my condition is"), blame ("I am suffering because of someone else's negligence"), a sense of unfairness ("It all seems so unfair"), and irreparability of loss ("My life will never be the same").
Cross-sectional studies show that high scores on perceptions of injustice are correlated with pain catastrophizing, fear of movement, and depression. Prospective studies show that high scores on perceived injustice are a prognostic indicator of poor rehabilitation outcomes and prolonged work disability. Research shows that perceptions of injustice interfere not only with physical recovery after injury, but perceptions of injustice also impact negatively on recovery of the mental health problems that might arise subsequent to traumatic injury. Although research has yet to address the process by which perceptions of injustice impact on pain-related outcomes systematically; possible mechanisms include attentional disengagement difficulties, emotional distress, maladaptive coping, heightened displays of pain behavior, anger, and revenge motives.
Perceived injustice appears to be associated with problematic health and mental health recovery trajectories after the onset of a pain condition. Future directions for research and treatment are addressed.

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Available from: Zina Trost, Apr 06, 2014
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    • "Fourth , we wanted to ensure that momentary pain did not originate from the day ' s work . An employee who gets hurt on the job may psychologically respond both to the perceived injustice ( Sullivan , Scott , and Trost , 2012 ) and to the somatic experience of pain itself , potentially muddling our results . "
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    • "The experience of pain and suffering is closely tied to perceptions of justice. Perceived injustice (ie, Why should I suffer more than others?) is associated with problematic pain outcomes, such as prolonged disability and mental illness [16] [17]. In experimental studies, pain perceived as being unfair significantly increased how many chocolates participants chose to eat [4]. "

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    • "The second dark lateral square on the left includes affective components of NSLBP. Prolonged guarded movements or muscle spasms can create or increase feelings of perceived injustice, thus anger or frustration [28]. Individuals start to become annoyed about the pain sensation and the resulting disability—which, again, can enhance muscle spasms or guarded movements as well. "
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