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Sources of injustice among individuals with persistent pain following musculoskeletal injury

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Abstract

Evidence supports the negative impact of perceived injustice on recovery following injury. However, little is known about sources that contribute to injustice perceptions in this context. Therefore, this study systematically investigated sources of injustice following painful musculoskeletal injury. Following completion of the Injustice Experiences Questionnaire (IEQ) and measures of pain, depression, and disability, participants completed a semi-structured interview to discuss reasons underlying their IEQ responses. On average, the sample was experiencing moderate levels of pain, depression, and disability, and clinically meaningful levels of perceived injustice. Participants frequently identified employers/colleagues, other drivers, insurers, healthcare providers, family, significant others, friends, and society as sources of injustice. Common reasons for identifying these sources included their contribution to the injury, inadequate assessment or treatment of pain, and punitive responses toward participants’ pain expression. Sex- and injury-related differences emerged in the identification of injustice sources. Potential strategies for preventing perceived injustice following painful injury are discussed.

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Acknowledgments

This research was supported by funds from the Canadian Institutes for Health Research, le Fonds de la Recherche en Santé du Québec, and l’Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail. The authors thank Véronique Boulais and Valérie Mallet for their assistance in data collection.

Conflict of interest

Whitney Scott, Amanda McEvoy, Rosalind Garland, Elena Bernier, Maria Milioto, Zina Trost, and Michael JL Sullivan declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional). Informed consent was obtained from all individual subjects participating in the study.

Animal rights

No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

    Whitney Scott

  2. Department of Psychology, Carlton University, Ottawa, ON, Canada

    Amanda McEvoy

  3. Ingram School of Nursing, McGill University, Montréal, QC, Canada

    Rosalind Garland

  4. Department of Psychology, McGill University, 1205 Doctor Penfield Avenue, Montréal, Quebec, H3A1B1, Canada

    Elena Bernier & Michael Sullivan

  5. Centre d’ Évaluation et de Réadaptation de l’Est, Montréal, QC, Canada

    Maria Milioto

  6. Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA

    Zina Trost

Authors
  1. Whitney Scott
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  4. Elena Bernier
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  7. Michael Sullivan
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Corresponding author

Correspondence to Michael Sullivan.

Appendix. Semi-structured interview schedule

Appendix. Semi-structured interview schedule

 

Questions and probes

Follow-up to IEQ item 1

You endorsed the statement, “Most people don’t understand how severe my condition is”:

- Who specifically does not understand the severity of your condition?

- Why do you feel this individual (or group) does not understand?

- Are there specific aspects about your condition that are not understood?

Follow-up to IEQ item 8

You endorsed the statement, “I worry that my condition is not being taken seriously”:

- Who specifically is not taking your condition seriously?

- Why do you feel this individual (or group) is not taking your condition seriously?

- Are there specific aspects about your condition that are not taken seriously?

Follow-up to IEQ item 3

You endorsed the statement, “I am suffering because of someone else’s negligence”:

- Who specifically has been negligent?

- How has this individual/group been negligent or contributed to your suffering?

Follow-up to IEQ item 10

You endorsed the statement, “I feel as if I have been robbed of something very precious”:

- Who has robbed you of this?

- How has this individual (or group) robbed you of this?

Additional questions

- Who was responsible for your initial injury?

- In the context of your pain condition, have you ever felt frustrated or angry in your interactions with your healthcare providers, insurer, employer, or significant other?

- If yes (for all sources that apply), what has this person done to make you frustrated or angry? Have you ever felt they did not understand your condition or were not giving you the treatment or support you deserved? Why did you feel this way?

IEQ Injustice Experiences Questionnaire

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Scott, W., McEvoy, A., Garland, R. et al. Sources of injustice among individuals with persistent pain following musculoskeletal injury. Psychol. Inj. and Law 9, 6–15 (2016). https://doi.org/10.1007/s12207-015-9249-8

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  • DOI: https://doi.org/10.1007/s12207-015-9249-8

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