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The Clinical Journal of Pain Summary

Highlight from The Clinical Journal of Pain (Volume 34, No. 8, August 2018)

The Impact of Perceived Injustice on Pain-Related Outcomes: A Combined Model Examining the Mediating Roles of Pain Acceptance and Anger in a Chronic Pain Sample

Junie S. Carriere, John A. Sturgeon, Esther Yakobov, Ming-Chih Kao, Sean C. Mackey, and Beth D. Darnall

Perceived injustice (PI) has been identified as a barrier to effective recovery and can help clinicians predict numerous adverse pain-related outcomes in patients with chronic pain. Notably, high levels of PI are associated with heightened pain behavior; more intense pain, self-reported disability, and medication use; and longer duration of work disability. Research suggests that PI may influence pain-related outcomes at least in part through its influence on pain acceptance. Pain acceptance involves discontinuing ineffective pain control strategies and continuing meaningful life activities even with pain. Researchers have identified PI as a cognitive antecedent to anger in patients with chronic pain and have discussed anger reactions as a central component to the experience of injustice.

This study examined the potential mediating roles of pain acceptance and anger on the association between PI and adverse pain outcomes in a sample of patients with chronic pain seeking specialized care. Investigators hypothesized that PI would be negatively associated with pain acceptance and positively associated with anger and that PI would be positively associated with adverse outcomes, such as pain intensity and opioid use status. They also predicted that both pain acceptance and anger would mediate the relationship between PI and pain-related outcomes.

Findings were consistent with previous research showing that PI is negatively associated with pain acceptance and positively associated with anger. Results also showed that high PI was associated with low physical function, high pain intensity, and active opioid use status. Pain acceptance also emerged as a partial mediator of the relationship between PI and pain intensity. These results revealed that only pain acceptance fully mediated the relationship between PI and physical function in patients with chronic pain. These findings support previous work demonstrating that pain acceptance mediates the relationship between PI and perceived disability, which may be considered a proxy for physical function.

Although anger has been consistently associated with both PI and pain outcomes, it does not explain the association between these variables once pain acceptance is accounted for. These findings highlight the importance of integrating interventions aimed at increasing pain acceptance in the treatment of chronic pain.