(124) Perceived Injustice Mediates the Relationship between Chronic Pain Stigma and Chronic Low Back Pain (CLBP) Severity

Abstract

Chronic low back pain (CLBP) is among the most pervasive, painful conditions in the United States. For most patients with CLBP, the cause is “non-specific” – meaning, there is no clear association between pain and identifiable pathology of the spine or associated tissues. Research has shown that laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with CLBP may feel their pain is particularly unjust, which in turn could contribute to greater CLBP severity. Further, emerging evidence suggests that pain-related injustice perception is a risk factor for poor CLBP outcomes. The purpose of this study was to examine whether perceived injustice mediates the relationship between chronic pain stigma and pain severity among individuals with CLBP. Study participants with CLBP (N = 44) completed the Internalized Chronic Pain Stigma Scale, the Injustice Experience Questionnaire, the Center for Epidemiological Studies – Depression Scale, and the Brief Pain Inventory – Short Form. In a regression-based model adjusted for depressive symptoms, findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and CLBP severity [Indirect Effect = 1.28, 95% CI: 0.06 to 3.08]. Specifically, greater chronic pain stigma was associated with greater perceived injustice (p = .0002), which in turn was associated with greater CLBP severity (p = .047). This study is the first to examine associations among chronic pain stigma, perceived injustice, and CLBP severity. Our findings suggest that injustice perception may be a mechanism through which stigma impacts CLBP severity. These findings reinforce the importance of further examining stigma and injustice appraisals as targets for intervention, especially among individuals with CLBP.