Abstract
The Injustice Experience Questionnaire (IEQ) assesses the degree to which chronic pain sufferers perceive injustice in relation to their pain. The aim of the current study was to assess the prevalence and relevance of the IEQ and its association to perceived recovery and deterioration in a naturalistic pain clinic population. Data was obtained from the Oslo University Hospital's Pain Registry. Among 2,950 patients, the prevalence of low (<19), medium (19-29) and high (30+) IEQ was 39%, 32% and 29% respectively. High levels of injustice were positively associated with a wide range of adverse health outcomes. Differences between those with high vs low levels of IEQ were clinically significant for most health outcomes. A Venn diagram analysis showed considerable, but not complete, overlap between IEQ, pain catastrophizing, psychological distress and severe pain intensity. High IEQ was associated with reduced clinical recovery (OR 0.6, 95% CI 0.4-0.9) and deterioration (OR 3.6, 95% CI 2.1-6.2) at 12-months follow-up, however, not when controlling for pain-related disability and pain intensity. We conclude that perceived injustice is a prevalent and clinically relevant phenomenon in a chronic pain clinic population, and that more knowledge is needed regarding its role as indicator of poor prognosis and target for tailored treatment. PerspectiveThis article shows that pain-related injustice is both prevalent and relevant in a large naturalistic pain clinic population. Higher levels of injustice were consistently associated with adverse pain outcomes. Injustice could as such be a viable target for treatment of chronic pain, with potential indirect effects on pain and disability.
Highlights
Pain-related injustice is an emerging concept with a growing body of literature demonstrating its role in prognosis and treatment outcome for people with various pain conditions 51
For pain-related disability, the mean Oswestry Disability Index (ODI) score was 13.4-point higher for patients with high compared to low Injustice Experience Questionnaire (IEQ), which is above the ≥ 10 % points indicating clinical significance
We found a positive trend in the proportion of clinically relevant cut-off scores for psychological distress, fatigue, insomnia, and pain catastrophizing by levels of IEQ (Table 2)
Summary
Pain-related injustice is an emerging concept with a growing body of literature demonstrating its role in prognosis and treatment outcome for people with various pain conditions 51. An experience of injustice in patients suffering from chronic pain comprises negative appraisals of the severity and irreparability of pain-related loss, attributions of blame, and a sense of unfairness 48. Unnecessary suffering as a result of another’s actions (e.g., whiplash injury after a vehicle accident), or a strong sense of loss (e.g., employment or other valued activities) due to the pain, can lead to patients feeling misunderstood and stigmatized, as well as increasing feelings of anger and perceptions of injustice 20. Such perceptions could drive hypervigilance towards painful sensations. The predictive value of attentional biases is debatable 59, hypervigilance towards pain-related stimuli is present in most people with chronic pain 61
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