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Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Perceptions of pain as unfair are a significant risk factor for poorer physical and psychological outcomes in acute injury and chronic pain. Chief among the negative emotions associated with perceived injustice is anger, arising through frustration of personal goals and unmet expectations regarding others’ behavior. However, despite a theoretical connection with anger, the social mediators of perceived injustice have not been demonstrated in chronic pain.

Purpose

The current study examined two socially based variables and a broader measure of pain interference as mediators of the relationships between perceived injustice and both anger and pain intensity in a sample of 302 patients in a tertiary care pain clinic setting.

Methods

Data from the Collaborative Health Outcomes Information Registry (CHOIR) were analyzed using cross-sectional path modeling analyses to examine social isolation, satisfaction with social roles and activities, and pain-related interference as potential mediators of the relationships between perceived injustice and both anger and pain intensity.

Results

When modeled simultaneously, ratings of social isolation mediated the relationship between perceived injustice and anger, while pain-related interference and social satisfaction did not. Neither social variable was found to mediate the relationship between perceived injustice and pain intensity, however.

Conclusions

The current findings highlight the strongly interpersonal nature of perceived injustice and anger in chronic pain, though these effects do not appear to extend to the intensity of pain itself. Nevertheless, the results highlight the need for interventions that ameliorate both maladaptive cognitive appraisal of pain and pain-related disruptions in social relationships.

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References

  1. Sullivan MJ, Adams H, Horan S, et al. The role of perceived injustice in the experience of chronic pain and disability: Scale development and validation. J Occup Rehabil. 2008; 18: 249-261.

    Article  PubMed  Google Scholar 

  2. Ferrari R. Perceived injustice in fibromyalgia and rheumatoid arthritis. Clin Rheumatol. 2014; 33: 1501-1507.

    Article  PubMed  Google Scholar 

  3. Scott W, Trost Z, Bernier E, et al. Anger differentially mediates the relationship between perceived injustice and chronic pain outcomes. Pain. 2013; 154: 1691-1698.

    Article  PubMed  Google Scholar 

  4. Sullivan MJ, Davidson N, Garfinkel B, et al. Perceived injustice is associated with heightened pain behavior and disability in individuals with whiplash injuries. Psychol Injury Law. 2009; 2: 238-247.

    Article  Google Scholar 

  5. Sullivan MJ, Adams H, Martel M-O, et al. Catastrophizing and perceived injustice: Risk factors for the transition to chronicity after whiplash injury. Spine. 2011; 36: S244-S249.

    Article  PubMed  Google Scholar 

  6. Trost Z, Scott W, Lange J, et al. An experimental investigation of the effect of a justice violation on pain experience and expression among individuals with high and low just world beliefs. Eur J Pain. 2014; 18: 415-423.

    Article  CAS  PubMed  Google Scholar 

  7. Yakobov E, Scott W, Stanish W. The role of perceived injustice in the prediction of pain and function after total knee arthroplasty. PAIN®. 2014; 155: 2040-2046.

    Article  Google Scholar 

  8. Scott W, Trost Z, Milioto M, et al. Further validation of a measure of injury-related injustice perceptions to identify risk for occupational disability: A prospective study of individuals with whiplash injury. J Occup Rehabil. 2013; 23: 557-565.

    Article  PubMed  Google Scholar 

  9. Scott W, Trost Z, Milioto M, et al. Barriers to change in depressive symptoms after multidisciplinary rehabilitation for whiplash: The role of perceived injustice. Clin J Pain. 2015; 31: 145-151.

    Article  PubMed  Google Scholar 

  10. Scott W, Sullivan M. Perceived injustice moderates the relationship between pain and depressive symptoms among individuals with persistent musculoskeletal pain. Pain Res Manag: J Can Pain Soc. 2012; 17: 335.

    Article  Google Scholar 

  11. Trost Z, Agtarap S, Scott W, et al. Perceived injustice after traumatic injury: Associations with pain, psychological distress, and quality of life outcomes 12 months after injury. Rehab Psychol. 2015; 60: 213.

    Article  Google Scholar 

  12. Yakobov E, Scott W, Tanzer M, et al. Validation of the injustice experiences questionnaire adapted for use with patients with severe osteoarthritis of the knee. J Arthrit. 2014; 3: 130-136.

    Article  Google Scholar 

  13. Sullivan MJ, Thibault P, Simmonds MJ, et al. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain. 2009; 145: 325-331.

    Article  PubMed  Google Scholar 

  14. Trost Z, Vangronsveld K, Linton SJ, et al. Cognitive dimensions of anger in chronic pain. Pain. 2012; 153: 515-517.

    Article  PubMed  Google Scholar 

  15. McParland JL, Eccleston C. “It’s not fair” social justice appraisals in the context of chronic pain. Curr Dir Psychol Sci. 2013; 22: 484-489.

    Article  Google Scholar 

  16. Sullivan MJ, Scott W, Trost Z. Perceived injustice: A risk factor for problematic pain outcomes. Clin J Pain. 2012; 28: 484-488.

    Article  PubMed  Google Scholar 

  17. Sturgeon JA, Dixon EA, Darnall BD, Mackey SC. Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: A Collaborative Health Outcomes Information Registry (CHOIR) Study. Pain. 2015.

  18. Evers AWM, Kraaimaat FW, Geenen R, et al. Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behav Res Ther. 2003; 41: 1295-1310.

    Article  PubMed  Google Scholar 

  19. Ferreira VM, Sherman AM. The relationship of optimism, pain and social support to well-being in older adults with osteoarthritis. Aging Ment Health. 2007; 11: 89-98.

    Article  CAS  PubMed  Google Scholar 

  20. Onoda K, Okamoto Y, Nakashima K, et al. Decreased ventral anterior cingulate cortex activity is associated with reduced social pain during emotional support. Soc Neurosci. 2009; 4: 443-454.

    Article  PubMed  Google Scholar 

  21. Sullivan MJ, Yakobov E, Scott W, et al. Perceived injustice and adverse recovery outcomes. Psychol Injury Law. 2014; 7: 325-334.

    Article  Google Scholar 

  22. Collaborative Health Outcomes Information Registry (CHOIR). from http://choir.stanford.edu.

  23. Gershon R, Rothrock NE, Hanrahan RT, et al. The development of a clinical outcomes survey research application: Assessment CenterSM. Qual Life Res. 2010; 19: 677-685.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kao MCJ, Cook, K., Olson, G., Pacht, T., Darnall, B.D., Weber, S.C., Mackey, S.C.: SNAPL-CAT: Catalyzing the rate-limiting step of big data psychometrics with item-response theory and advanced computerized adaptive testing (poster presentation). American Medical Informatics Associations (AMIA) 2014 Joint Summits on Translational Science. San Francisco, CA, 2014

  25. Cella D, Gershon R, Lai J-S, et al. The future of outcomes measurement: Item banking, tailored short-forms, and computerized adaptive assessment. Qual Life Res. 2007; 16: 133-141.

    Article  PubMed  Google Scholar 

  26. Sturgeon JA, Darnall BD, Kao M-CJ, et al. Physical and psychological correlates of fatigue and physical function: A Collaborative Health Outcomes Information Registry (CHOIR) Study. J Pain. 2014; 16: 291-298.e291.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rodero B, Luciano JV, Montero-Marín J, et al. Perceived injustice in fibromyalgia: Psychometric characteristics of the Injustice Experience Questionnaire and relationship with pain catastrophising and pain acceptance. J Psychosom Res. 2012; 73: 86-91.

    Article  PubMed  Google Scholar 

  28. Farrar JT, Young JP Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001; 94: 149-158.

    Article  CAS  PubMed  Google Scholar 

  29. Cook KF, Dunn W, Griffith JW, et al. Pain assessment using the NIH Toolbox. Neurology. 2013; 80: S49-S53.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cella D, Yount S, Rothrock N, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap cooperative group during its first two years. Med Care. 2007; 45: S3-S11.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Amtmann D, Cook KF, Jensen MP, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010; 150: 173-182.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hays RD, Bjorner JB, Revicki DA, et al. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009; 18: 873-880.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Fries JF, Cella D, Rose M, et al. Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing. J Rheumatol. 2009; 36: 2061-2066.

    Article  PubMed  Google Scholar 

  34. Muthén LK, Muthén BO. Mplus: Statistical analysis with latent variables; user’s guide; [version 5]: Muthén & Muthén, 2007.

  35. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivar Behav Res. 2004; 39: 99-128.

    Article  Google Scholar 

  36. Smith RH, Parrott WG, Ozer D, et al. Subjective injustice and inferiority as predictors of hostile and depressive feelings in envy. Personal Soc Psychol Bull. 1994; 20: 705-711.

    Article  Google Scholar 

  37. Kawakami K, Dion KL. Social identity and affect as determinants of collective action toward an integration of relative deprivation and social identity theories. Theor Psychol. 1995; 5: 551-577.

    Article  Google Scholar 

  38. Fernandez E, Turk DC. The scope and significance of anger in the experience of chronic pain. Pain. 1995; 61: 165-175.

    Article  CAS  PubMed  Google Scholar 

  39. Scott W, McCracken LM, Trost Z. A psychological flexibility conceptualisation of the experience of injustice among individuals with chronic pain. British J Pain. 2013:2049463713514736.

  40. McCracken LM, Morley S. The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. J Pain. 2014; 15: 221-234.

    Article  PubMed  Google Scholar 

  41. McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. Am Psychol. 2014; 69: 178.

    Article  PubMed  Google Scholar 

  42. Zautra A, IF J, Zautra E, et al. The humanization of social relations: Nourishment for resilience in mid-life. In: Ong A, Löckenhoff C, eds. New Developments in Emotional Aging. Washington, DC: American Psychological Association; 2016.

    Google Scholar 

  43. Zautra AJ: Fostering resilience to chronic pain through the humanization of social relations. Advancing Pain Care through Behavior Change Science & Mobile Health Technologies Conference: The Translational Research Institute on Pain in Later Life (TRIPLL). Cornell Medical School, New York City, New York: 2015

  44. De Ruddere L, Goubert L, Stevens MAL, et al. Health care professionals’ reactions to patient pain: Impact of knowledge about medical evidence and psychosocial influences. J Pain. 2014; 15: 262-270.

    Article  PubMed  Google Scholar 

  45. Newton BJ, Southall JL, Raphael JH, et al. A narrative review of the impact of disbelief in chronic pain. Pain Manag Nurs. 2013; 14: 161-171.

    Article  PubMed  Google Scholar 

  46. McParland JL, Eccleston C, Osborn M, et al. It’s not fair: An interpretative phenomenological analysis of discourses of justice and fairness in chronic pain. Health. 2011; 15: 459-474.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge funding from the National Institutes of Health (NIH HHSN 271201200728P, NIH K24 DA029262, NIH P01 AT006651, and NIH/NIDA 3T32DA035165-02S1), as well as the Redlich Pain Endowment.

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

John A. Sturgeon, Junie S. Carriere, Ming-Chih J. Kao, Thomas Rico, Beth D. Darnall, and Sean C. Mackey declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Authors and Affiliations

  1. Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, 94304, USA

    John A. Sturgeon PhD, Ming-Chih J. Kao MD, PhD, Thomas Rico BS, Beth D. Darnall PhD & Sean C. Mackey MD, PhD

  2. Department of Psychology, McGill University, 1205 Docteur Penfield Ave., Montreal, QC, J3A 1B1, Canada

    Junie S. Carriere BA

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  1. John A. Sturgeon PhD
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  2. Junie S. Carriere BA
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  6. Sean C. Mackey MD, PhD
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Correspondence to John A. Sturgeon PhD.

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Sturgeon, J.A., Carriere, J.S., Kao, MC.J. et al. Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study. ann. behav. med. 50, 802–812 (2016). https://doi.org/10.1007/s12160-016-9808-6

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  • DOI: https://doi.org/10.1007/s12160-016-9808-6

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