Pain Acceptance Partially Mediates the Relationship Between Perceived Injustice and Pain Outcomes Over 3 Months

Abstract

Perceived injustice is a maladaptive cognitive appraisal of pain or injury, characterized by attributions of blame, unfairness, severity of loss, and irreparability of loss. Research suggests that perceived injustice may negatively affect pain outcomes by inhibiting the development of pain-related acceptance. The current study aimed to extend cross-sectional research by testing whether pain acceptance mediates the effects of perceived injustice on pain-related outcomes longitudinally. Data was analyzed from a prospective study to examine the potential mediating role of pain acceptance on recovery 3 months after an episode of low back pain. Using Mechanical Turk, we recruited participants who experienced an episode of back pain within the preceding 2 weeks, 343 of whom completed measures of perceived injustice, pain acceptance, pain ratings, and quality of life at each of 3 timepoints (recruitment, 1 mo later, and 3 mo later). Path analyses were conducted to examine pain acceptance at 1 month as a potential mediator of the relationship between perceived injustice at recruitment and pain intensity, disability, and depressive symptoms at 3 months. Results indicated that perceived injustice at recruitment was directly related to pain intensity, disability, and depressive symptoms 3 months later, and that pain acceptance partially mediated these relationships. Although these findings provide further support for pain acceptance as a buffer for the deleterious effects of perceived injustice, they also highlight that adjunctive mechanisms should be investigated to provide more comprehensive clinical insight.