Journal of Occupational Rehabilitation

, Volume 18, Issue 3, pp 249–261 | Cite as

The Role of Perceived Injustice in the Experience of Chronic Pain and Disability: Scale Development and Validation

  • Michael J. L. Sullivan
  • Heather Adams
  • Sharon Horan
  • Denise Maher
  • Dan Boland
  • Richard Gross


Introduction The primary objective of this research was to evaluate the psychometric properties of a questionnaire designed to assess perceive injustice associated with injury. Methods In Study 1, the 12-item Injustice Experience Questionnaire (IEQ) was administered to 226 individuals with musculoskeletal conditions. A subsample of 85 individuals were interviewed 1-year later about their ongoing symptoms and return to work status. In Study 2, the IEQ and other pain-related measures were administered on two separate occasions to 70 pain patients participating in a functional restoration rehabilitation program. Results—Study 1 Principal components analysis yielded a two-component solution with eigenvalues greater 1. Item content of the two components reflected elements of blame and irreparability of loss. In cross sectional analyses, the IEQ was significantly correlated with measures of catastrophic thinking, r = .75, P < .01, fear of movement/re-injury, r = .58, P < .01, depression, r = .66, P < .01, and pain severity, r = .54, P < .01. Cross-sectional regression analyses revealed that the IEQ, β = .44, P < .01, and the PCS, β = .18, P < .05, each contributed significant unique variance to the prediction of pain severity. The IEQ prospectively predicted return to work status, OR = .75, 95% CI = .58–.99, but not pain severity. Results—Study 2 Analyses supported the test re-test reliability of the IEQ, r = .90, P < .01. Treatment-related changes in the IEQ were significantly correlated with an objective index of improved physical function, r = .51, P < .01. Conclusions The findings of these two studies support the construct validity of the IEQ and suggest that this measure might be a useful complement to psychosocial assessment of individuals with persistent pain conditions. Discussion addresses the processes through which perceived injustice might impact on disability and rehabilitation outcomes.


Perceived injustice Catastrophizing Pain Disability Victimisation 


  1. 1.
    Keogh JP, Nuwayhid I, Gordon JL, Gucer PW. The impact of occupational injury on the injured worker and family. Am J Ind Med. 2000;38:498–506. doi:10.1002/1097-0274(200011)38:5<498::AID-AJIM2>3.0.CO;2-I.PubMedCrossRefGoogle Scholar
  2. 2.
    Chapman CR, Gavrin J. Suffering: the contributions of persistent pain. Lancet. 1999;353:2233–37. doi:10.1016/S0140-6736(99)01308-2.PubMedCrossRefGoogle Scholar
  3. 3.
    Berglund A, Bodin L, Jensen I, Wiklund A, Alfredsson L. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. 2006;125(3):244–56. doi:10.1016/j.pain.2006.05.026.PubMedCrossRefGoogle Scholar
  4. 4.
    Nederhand MJ, Hermens HJ, Ijzerman MJ, Turk DC, Zilvold G. Chronic pain disabillity due to an acute whiplash injury. Pain. 2003;102:63–71. doi:10.1016/s0304-3959(02)00340-8.PubMedCrossRefGoogle Scholar
  5. 5.
    Sullivan MJ, Sullivan ME, Adams H. Stage of chronicity and cognitive correlates of pain-related disability. Cogn Behav Ther. 2002;31:111–8. doi:10.1080/165060702320337988.CrossRefGoogle Scholar
  6. 6.
    Lyons R, Sullivan M. Curbing loss in illness and disability. In: Harvey J, editor. Perspectives on personal and interpersonal loss. New York: Taylor & Francis; 1998.Google Scholar
  7. 7.
    Harris S, Morley S, Barton SB. Role loss and emotional adjustment in chronic pain. Pain. 2003;105:363–70. doi:10.1016/S0304-3959(03)00251-3.PubMedCrossRefGoogle Scholar
  8. 8.
    Suissa S. Risk factors for poor prognosis after whiplash injury. Pain Res Manag. 2003;8:69–75.PubMedGoogle Scholar
  9. 9.
    Watson PJ, Booker CK, Moores L, Main C. Returning the chronically unemployed with low back pain to employment. Eur J Pain. 2004;8:359–69. doi:10.1016/j.ejpain.2003.11.003.PubMedCrossRefGoogle Scholar
  10. 10.
    Evans TH, Mayer TG, Gatchel RJ. Recurrent disabling work-related spinal disorders after prior injury claims in a chronic low back pain population. Spine J. 2001;1:183–9. doi:10.1016/S1529-9430(01)00079-1.PubMedCrossRefGoogle Scholar
  11. 11.
    Miller DT. Disrespect and the experience of injustice. Annu Rev Psychol. 2001;52:527–53. doi:10.1146/annurev.psych.52.1.527.PubMedCrossRefGoogle Scholar
  12. 12.
    Hamilton VL, Hagiwara S. Roles, responsibility and accounts across cultures. Int J Psychol. 1992;27:157–79. doi:10.1080/00207599208246873.CrossRefGoogle Scholar
  13. 13.
    Lind EA, Tyler TR. The social psychology of procedural justice. New York: Plenum; 1988.Google Scholar
  14. 14.
    Mohiyeddini C, Schmitt MJ. Sensitivity to befallen injustice and reactions to unfair treatment in a laboratory situation. Soc Justice Res. 1997;10:333–53. doi:10.1007/BF02683307.CrossRefGoogle Scholar
  15. 15.
    Fetchenhauer D, Huang X. Justice sensitivity and distributive decisions in experimental games. Personality Individ Differ. 2004;36:1015–29. doi:10.1016/S0191-8869(03)00197-1.CrossRefGoogle Scholar
  16. 16.
    Hafer CL, Begue L. Experimental research on Just-World Theory: problems, developments and future challenges. Psychol Bull. 2005;131:128–67. doi:10.1037/0033-2909.131.1.128.PubMedCrossRefGoogle Scholar
  17. 17.
    Strang H, Braithwaite J. Restorative justice: from philosophy to practice. Dartmouth, CT: Aldershot Press; 2000.Google Scholar
  18. 18.
    Blyth FM, March LM, Nicholas MK, Cousins MJ. Chronic pain, work performance and litigation. Pain. 2003;103:41–7. doi:10.1016/S0304-3959(02)00380-9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ferrari R, Russell A. Why blame is factor in recovery from whiplash injury. Med Hyp. 2001;56:372–75. doi:10.1054/mehy.2000.1215.CrossRefGoogle Scholar
  20. 20.
    Gun RT, Osti OL. Risk factors for prolonged disability after whiplash injury: a prospective study. Spine. 2005;30:386–91. doi:10.1097/ Scholar
  21. 21.
    Turk DC, Okifuji A. Perception of traumatic onset, compensation status, and physical findings: impact on pain severity, emotional distress, and disability in chronic pain patients. J Behav Med. 1996;19(5):435–53. doi:10.1007/BF01857677.PubMedCrossRefGoogle Scholar
  22. 22.
    Mikula G, Scherer KR, Athenstaedt U. The role of injustice in the elicitation of differential emotional reactions. Pers Soc Psychol Bull. 1998;24:769–83. doi:10.1177/0146167298247009.CrossRefGoogle Scholar
  23. 23.
    Sullivan M, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32. doi:10.1037/1040-3590.7.4.524.CrossRefGoogle Scholar
  24. 24.
    Beugre CD. Reacting aggressively to injustice at work: a cognitive stage model. J Bus Psychol. 2006;20:291–301. doi:10.1007/s10869-005-8265-1.CrossRefGoogle Scholar
  25. 25.
    Sullivan MJ, Stanish WD. Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program. Clin J Pain. 2003;19(2):97–104. doi:10.1097/00002508-200303000-00004.PubMedCrossRefGoogle Scholar
  26. 26.
    Sullivan MJ, Stanish W, Waite H, Sullivan M, Tripp DA. Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain. 1998;77(3):253–60. doi:10.1016/S0304-3959(98)00097-9.PubMedCrossRefGoogle Scholar
  27. 27.
    Kori S, Miller R, Todd D. Kinesiophobia: a new view of chronic pain behavior. Pain Manag. 1990;Jan/Feb:35–43.Google Scholar
  28. 28.
    Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72. doi:10.1016/0304-3959(94)00279-N.PubMedCrossRefGoogle Scholar
  29. 29.
    Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1–2):329–39. doi:10.1016/S0304-3959(98)00229-2.PubMedCrossRefGoogle Scholar
  30. 30.
    Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol. 2002;156(11):1028–34. doi:10.1093/aje/kwf136.PubMedCrossRefGoogle Scholar
  31. 31.
    Beck A, Steer R, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio TX: Psychological Corporation; 1996.Google Scholar
  32. 32.
    Vowles KE, Gross RT, Sorrell JT. Predicting work status following interdisciplinary treatment for chronic pain. Eur J Pain. 2004;8(4):351–58. doi:10.1016/j.ejpain.2003.10.009.PubMedCrossRefGoogle Scholar
  33. 33.
    Poole H, Bramwell R, Murphy P. Factor structure of the Beck Depression Inventory-II in patients with chronic pain. Clin J Pain. 2006;22(9):790–98. doi:10.1097/01.ajp.0000210930.20322.93.PubMedCrossRefGoogle Scholar
  34. 34.
    Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984;59(3):974.PubMedGoogle Scholar
  35. 35.
    Tait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain. 1990;40(2):171–82. doi:10.1016/0304-3959(90)90068-O.PubMedCrossRefGoogle Scholar
  36. 36.
    Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The Pain Disability Index: psychometric and validity data. Arch Phys Med Rehabil. 1987;68(7):438–41.PubMedGoogle Scholar
  37. 37.
    Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1:277–99. doi:10.1016/0304-3959(75)90044-5.PubMedCrossRefGoogle Scholar
  38. 38.
    Turk DC, Rudy T, Salovey P. The McGill Pain Questionnaire: confirming the factor analysis and examining appropriate uses. Pain. 1985;21:385–97. doi:10.1016/0304-3959(85)90167-8.PubMedCrossRefGoogle Scholar
  39. 39.
    Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334. doi:10.1007/BF02310555.CrossRefGoogle Scholar
  40. 40.
    Sullivan M, Adams A, Rhodenizer T, Stanish W. A psychosocial risk factor targeted intervention for the prevention of chronic pain and disability following whiplash injury. Phys Ther. 2006;86:8–18.PubMedGoogle Scholar
  41. 41.
    Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17(1):52–64. doi:10.1097/00002508-200103000-00008.PubMedCrossRefGoogle Scholar
  42. 42.
    Simmonds M, Olson S, Novy D, Jones S, Hussein T, Lee C, et al. Physical performance tests: are they psychometrically sound and clinically useful for patients with low back pain? Spine.. 1999;23:2412–21. doi:10.1097/00007632-199811150-00011.CrossRefGoogle Scholar
  43. 43.
    Simmonds MN, Soval R. The influence of pain and fatigue on physical performance and health status in ambulatory patients with HIV. Clin J Pain. 2005;21(3):200–6. doi:10.1097/00002508-200505000-00002.PubMedCrossRefGoogle Scholar
  44. 44.
    Annes J. An introduction to Plato’s republic. Oxford, UK: Oxford University Press; 1982.Google Scholar
  45. 45.
    Marenbon J. Early medieval philosophy. Oxford, UK: Oxford University Press; 1997.Google Scholar
  46. 46.
    Hart HLA. Punishment and responsibility: essays in the philosophy of law. Oxford, UK: Oxford University Press; 1995.Google Scholar
  47. 47.
    Shavell S. The fundamental divergence between the private and the social motive to use the legal system. J Legal Stud. 1997;26:575–612. doi:10.1086/468008.CrossRefGoogle Scholar
  48. 48.
    DeGood DE, Kiernan B. Perception of fault in patients with chronic pain. Pain. 1996;64:153–9. doi:10.1016/0304-3959(95)00090-9.PubMedCrossRefGoogle Scholar
  49. 49.
    Aceves-Avila FJ, Ferrari R, Ramos-Remus C. New insights into culture driven disorders. Best Pract Res Clin Rheumatol. 2004;18:155–71. doi:10.1016/j.berh.2004.02.004.PubMedCrossRefGoogle Scholar
  50. 50.
    Bigos SJ, Battie MC. Acute care to prevent back disability. Clin Orthop. 1987;221:212–30.Google Scholar
  51. 51.
    Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–32. doi:10.1016/S0304-3959(99)00242-0.PubMedCrossRefGoogle Scholar
  52. 52.
    Sullivan MJL, Rouse D, Bishop SR, Johnston S. Thought suppression, catastrophizing and pain. Cognit Ther Res. 1997;21:555–68. doi:10.1023/A:1021809519002.CrossRefGoogle Scholar
  53. 53.
    Van Damme S, Crombez G, Eccleston C. Disengagement from pain: the role of catastrophic thinking about pain. Pain. 2004;107(1–2):70–6. doi:10.1016/j.pain.2003.09.023.PubMedGoogle Scholar
  54. 54.
    Aquino K, Tripp TM, Bies RJ. How employees respond to personal offense: the effects of blame attribution, victim status, and offender status on revenge and reconciliation in the workplace. J Appl Psychol. 2001;86:52–9. doi:10.1037/0021-9010.86.1.52.PubMedCrossRefGoogle Scholar
  55. 55.
    Ferguson TJ, Rule BG. An attributional perspective on anger and aggression. In: Green RG, Donnerstein E, editors. Aggression: theoretical and empirical perspectives. New York: Acedemic Press; 1983. p. 41–74.Google Scholar
  56. 56.
    Aquino K, Douglas S, Martinko MJ. Overt anger in response to victimization: attributional style and organizational norms as moderators. J Occup Health Psychol. 2004;9:152–64. doi:10.1037/1076-8998.9.2.152.PubMedCrossRefGoogle Scholar
  57. 57.
    Anderson CA, Bushman BJ. Human aggression. Annu Rev Psychol. 2002;53:27–51. doi:10.1146/annurev.psych.53.100901.135231.PubMedCrossRefGoogle Scholar
  58. 58.
    Clayton SD. The experince of injustice: some characteristics and correlates. Soc Justice Res. 2005;5:71–91. doi:10.1007/BF01048378.CrossRefGoogle Scholar
  59. 59.
    Arrmstrong-Stassen M. The effect of gender and organizational level on how survivors appraise and cope with organizational downsizing. J Appl Behav Sci. 1998;34:125–42. doi:10.1177/0021886398342001.CrossRefGoogle Scholar
  60. 60.
    Berkowitz L. Pain and aggression: some findings and implications. Motiv Emot. 1993;17:277–93. doi:10.1007/BF00992223.CrossRefGoogle Scholar
  61. 61.
    Kerns RD, Rosenberg R, Jacob MC. Anger expression and chronic pain. J Behav Med. 1994;17(1):57–67. doi:10.1007/BF01856882.PubMedCrossRefGoogle Scholar
  62. 62.
    Burns JW, Bruehl S. Anger management style, opioid analgesic use, and chronic pain severity: a test of the opioid-deficit hypothesis. J Behav Med. 2005;28(6):555–63. doi:10.1007/s10865-005-9020-9.PubMedCrossRefGoogle Scholar
  63. 63.
    Bruehl S, Chung OY, Burns JW, Biridepalli S. The association between anger expression and chronic pain intensity: evidence for partial mediation by endogenous opioid dysfunction. Pain. 2003;106(3):317–24. doi:10.1016/S0304-3959(03)00319-1.PubMedCrossRefGoogle Scholar
  64. 64.
    Orth U, Montada L, Maercker A. Feelings of revenge, retaliation motive, and post-traumatic stress reactions in crime victims. J Interpers Violence. 2006;21:229–43. doi:10.1177/0886260505282286.PubMedCrossRefGoogle Scholar
  65. 65.
    Bruehl S, Chung OY, Burns JW. Differential effects of expressive anger regulation on chronic pain intensity in CRPS and non-CRPS limb pain patients. Pain. 2003;104(3):647–54. doi:10.1016/S0304-3959(03)00135-0.PubMedCrossRefGoogle Scholar
  66. 66.
    McCracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain. 2003;105:197–204. doi:10.1016/S0304-3959(03)00202-1.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Michael J. L. Sullivan
    • 1
  • Heather Adams
    • 2
  • Sharon Horan
    • 3
  • Denise Maher
    • 4
  • Dan Boland
    • 5
  • Richard Gross
    • 6
  1. 1.Department of PsychologyMcGill UniversityMontrealCanada
  2. 2.Faculty of MedicineMcGill University Health CentreMontrealCanada
  3. 3.Fit for Work Inc.St. JohnsCanada
  4. 4.Fit for Work Inc.St. JohnsCanada
  5. 5.Eastern Rehabilitation Inc., CBI HealthHalifaxCanada
  6. 6.LifeMark Health CenterDartmouthCanada

Personalised recommendations