Abstract

413 ISSN 1758-1869 10.2217/PMT.13.55 © 2013 Future Medicine Ltd Pain Manage. (2013) 3(6), 413–416 Twenty years ago, heated debates would arise during discussions of psychological influences on pain experience. Today there is little room for debate. Indeed, research has been consistent in showing that certain psychosocial variables can increase the risk of problematic pain outcomes [1]. This editorial will focus on two psychosocial variables that have emerged as significant predictors of problematic pain outcomes. These include catastrophic thinking and perceived injustice [1]. Numerous investigations suggest that individuals who engage in catastrophic or alarmist thinking about their symptoms, and who feel that they are suffering unjustly, are individuals at high risk for developing chronic pain and disability. The predictive value of catastrophizing, and perceived injustice for adverse pain outcomes has been so robust, that these psychosocial variables have risen to the status of ‘risk factors’ for problematic recovery [1]. Pain catastrophizing has been broadly defined as an exaggerated negative orientation to actual or anticipated pain comprising elements of rumination, magnification and helplessness [2]. Over 1000 studies have documented a relationship between pain catastrophizing and adverse pain outcomes [2,3]. Pain catastrophizing has been associated with heightened pain severity, emotional distress and pain-related disability, even when controlling for medical status variables [2,4]. Pain catastrophizing has also been shown to compromise the effectiveness of pharmacological and psychological pain management interventions. Several studies have shown that reduction in pain catastrophizing is the single best predictor of successful rehabilitation for pain-related conditions [5,6]. Perceived injustice has been conceptualized as a cognitive appraisal involving a tendency to magnify the severity of painrelated losses, a sense that losses are irreparable and blame attributions [7]. Research indicates that perceptions of injustice are associated with heightened pain severity, pain behaviors, self-reported disability, depressive symptoms and the persistence of post-traumatic stress symptoms [7]. Perceived injustice predicts prolonged occupational disability following injury, even when controlling for pain catastrophizing, fear of movement and depressive symptoms [7]. Reductions in Injustice Experiences Questionnaire (IEQ) scores have

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