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
    • "Accumulating research suggests that, for some individuals , life following painful injury might be experienced with a sense of injustice.[1]In the context of painful injury, perceived injustice has been operationalized as an appraisal of the severity and irreparability of pain-related losses, a sense of unfairness, and blame attributions.[2]A "
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    ABSTRACT: Purpose Accumulating research suggests that perceived injustice is a risk factor for adverse recovery following painful injury. Presently, however, little is known about the processes by which perceived injustice influences rehabilitation outcomes. It is plausible that perceived injustice and associated anger impact rehabilitation outcomes by compromising the quality of the therapeutic working alliance; however, research has not previously examined the relationship between perceived injustice and the working alliance. Therefore, the present study investigated the association between perceived injustice, anger, and the working alliance. Methods Sixty-six patients with persistent pain following musculoskeletal injury participated in this study. All participants were enrolled in a standardized multidisciplinary rehabilitation programme. Participants completed self-report measures of perceived injustice, pain intensity, disability, anger intensity and regulation style, depressive symptoms, and a measure of the working alliance with their principal rehabilitation clinician. Each participant’s principal clinician also completed the working alliance measure. Results Greater perceptions of injustice were associated with poorer client ratings of the working alliance. Results also showed that anger expression mediated the association between perceived injustice and the working alliance. Conclusion Strategies to enhance the working alliance between rehabilitation professionals and clients with elevated levels of perceived injustice are needed.Implications for RehabilitationPerceived injustice is associated with poor progress in rehabilitation programmes for people with musculoskeletal pain following injury.Perceived injustice is negatively associated with the quality of the therapeutic working alliance.Strategies to enhance the working alliance between rehabilitation professionals and clients with elevated levels of perceived injustice are needed.
    No preview · Article · Jan 2016 · Disability and Rehabilitation
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    • "Although the literature indicates that individuals with chronic pain identify multiple sources of blame for their suffering (DeGood & Kiernan, 1996), researchers have only speculated on the relationship between perceived injustice and retribution motives (Sullivan et al., 2014;Sullivan et al., 2012). For instance, it has been suggested that individuals may engage in retribution by demonstrating treatment noncompliance , expressing anger, or maintaining prolonged disability behavior (Sullivan et al., 2014;Sullivan et al., 2012). Thus, the relationship between injustice and retribution is also posited as a mechanism by which injustice perception may have a negative impact. "
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    ABSTRACT: The current study examined the association between perceived injustice (assessed by the Injustice Experiences Questionnaire) and intent to litigate in a sample of individuals who had recently suffered a spinal cord injury and were currently on an inpatient rehabilitation unit. Higher perception of injustice was associated with reported interest in litigation. In logistic regression analyses, perceived injustice uniquely differentiated between individuals who foresaw involvement in litigation versus those who did not, with the blame/unfairness factor of the Injustice Experiences Questionnaire emerging as more significant than the severity/irreparability of loss factor. Both anticipated litigation and higher perception of injustice were associated with greater attribution of responsibility for injury to other person(s) and reduced forgiveness across a number of domains. Finally, a receiver operating characteristic (ROC) curve analysis was conducted to identify IEQ score most associated with anticipated litigation. This study is the first to examine perception of injustice in a spinal cord injury sample or the association between perceived injustice and litigation intent. Results support the possibility that psychological appraisals of injury may have significant legal ramifications.
    Full-text · Article · Jan 2016 · Psychological Injury and Law
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    • "Recent investigations using the IEQ to measure perceptions of injustice among persons with chronic pain suggest that it is a robust clinical construct. Studies have shown that it is associated with depression (Scott & Sullivan, 2012), poor treatment outcomes (Sullivan, Scott, & Trost, 2012), high levels of pain behavior (Sullivan et al., 2009), and prolonged disability (Scott, Trost, Milioto, & Sullivan, 2013; Sullivan et al., 2008). "
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    ABSTRACT: Workers’ compensation systems represent naturalistic settings that often are perceived as unjust by the injured workers for which such systems were developed. This study examined the role of dissatisfaction with medical care and employer treatment on disability outcomes among a cohort of workers who had sustained low back injuries. A race-stratified sample of 358 workers (171 African-Americans, 203 Caucasians) with first incident low back pain was evaluated 21 months and again at 72 months after claim settlement. Evaluation included data related to demographics, socioeconomic factors, injury severity, claim settlement, satisfaction with workers’ compensation (WC) processes, and disability status. Multinomial logistic regression analysis was used to predict disability status (no disability vs. early disability vs. late disability) at each of the two time points. Analyses revealed contributions of multiple variables to early disability, including unique variance related to dissatisfaction with medical care and treatment by the employer. At 72 months, only demographic factors (age, race) and the receipt of temporary total disability (TTD) after injury predicted late disability. Results are discussed relative to the contribution of injustice perceptions and systemic factors; directions for future research are proposed.
    Full-text · Article · Dec 2015 · Psychological Injury and Law
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