Injustice Experience Questionnaire Research Articles

Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire.

Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ. We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity. We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity. Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.

Translation and adaptation of the Arabic version of the injustice experience questionnaire in patients with chronic musculoskeletal pain.

The objectives of this study were to (1) translate the short version of the Injustice Experience Questionnaire (IEQ-SF) from English to Arabic and (2) test the validity and reliability of the translated Arabic version of the IEQ-SF. A cross-sectional study in which the original English version of the IEQ-SF was translated into Arabic was conducted in accordance with Beaton's translation process. Internal consistency, reproducibility (retest within 5 days), and validity of the translated Arabic version of the IEQ-SF were tested in Arabic-speaking participants (n = 20). Individuals with chronic pain (n = 99) completed the Arabic versions of the IEQ-SF and the Musculoskeletal Health Questionnaire (MSK-HQ) from June to August 2021. The main analyses included Cronbach's alpha (α), Intraclass Correlation Coefficients (ICC), and Spearman's rank correlations (ρ). The internal consistency (α = 0.74) and test-retest reliability (ICC = 0.88, 0.83-0.92 95% CI) for the translated Arabic version of IEQ-SF were high. There was also a high correlation between the translated Arabic version of the IEQ-SF and different health-related questionnaires such as the MSK-HQ (ρ = -0.738; p < 0.001), Hospital Anxiety and Depression Scale (ρ = 0.701-0.791; all, p < 0.001), and Pain Catastrophizing Scale (ρ = 0.762; p < 0.001). The Arabic version of the IEQ-SF demonstrated high reliability and validity and would be useful for clinicians and researchers studying Arabic-speaking individuals with chronic pain.

Development and Validation of the Simplified Chinese Version of the Injustice Experience Questionnaire with Cross-Cultural Adaptation

Development and Validation of the Simplified Chinese Version of the Injustice Experience Questionnaire with Cross-Cultural Adaptation

Cross-cultural adaptation and validation of Injustice Experience Questionnaire in Greek

Purpose The Injustice Experience Questionnaire (IEQ) gauges the extent to which individuals with chronic pain perceive feelings of injustice concerning their pain. The study’s objective was to assess the feasibility, absolute and relative reliability, as well as the convergent and construct validity of the Greek version of the IEQ. Methods A cross-cultural adaptation of the IEQ in Greek was carried out according to the published guidelines. Ninety patients with chronic pain and 44 healthy participants completed the IEQ-GR, the Pain Catastrophizing Scale (PCS), and the Hospital Anxiety and Depression Scale (HADS). A subset of 36 volunteers completed the IEQ-GR twice over 1 week. Results The ICC was calculated at 0.98 for IEQ-total and 0.83–0.96 for all items. The Cronbach’s a was estimated at 0.98 for IEQ-total and 0.91–0.98 for all items. The SEM ranged from 0.20 to 1.63 and the SDC was 0.36–2.62 for all items. Positive and significant correlations between IEQ-GR and PCS (r = 0.59, p < 0.01), HADS (r = 0.58, p < 0.01), HADS depression (r = 0.50, p < 0.01), and HADS anxiety (r = 0.55, p < 0.01), were found. There was a statistically significant difference in IEQ between the patient and control groups. Conclusions The IEQ-GR demonstrated excellent reliability, internal consistency, convergent and discriminant validity in a Greek population.

Perceived Injustice in Cancer Survivors: Population-Specific Cut-Off Score and Relations with Personal Factors, Symptoms and Quality of Life-A Cross-Sectional Study.

Fatigue and pain are the most common side effects impacting quality of life (QoL) in cancer survivors. Recent insights have shown that perceived injustice (PI) can play a substantial role in these side effects, but research on cancer survivors is scarce. Furthermore, guidelines for recognizing clinically relevant levels of PI in cancer survivors are missing. The aims of this study are to provide a clinically relevant cut-off for PI and to explore relationships between personal characteristics, symptoms, and QoL with PI. This multicenter, cross-sectional study uses the Injustice Experience Questionnaire (IEQ), Numeric Pain Rating Scale (NPRS), Patient-Specific Complaints (PSC), Multidimensional Fatigue Index (MFI), and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (EORTC-QLQ-C30). A clinical cut-off for PI was identified based on the 75th percentile of IEQ scores. Univariate and multivariate regressions explored the relationship between PI and personal characteristics (sex, age, cancer type, treatment type), symptoms (pain intensity, fatigue), and QoL (daily activity complaints, cancer-related QoL). Cancer survivors (n = 121) were included, and a cut-off of 20 was identified. Significant indirect associations were found between chemotherapy, NPRS, PSC, MFI, and EORTC-QLQ-C30 with PI. In the multivariate model, only MFI (B = 0.205; 95% CI: 0.125-0.018) and age (B = 0.086; 95% CI: -0.191-0.285) maintained a significant association with PI.

Youth baseline and state pain-related injustice appraisals are associated with emotional responses of anger and sadness: An experimental study.

Youth pain-related injustice appraisals are associated with adverse functioning; however, mechanisms by which injustice appraisals exert their impact have yet to be elucidated. Adult injustice literature suggests anger, sadness, and attention bias to anger (AB) as potential mechanisms. This study examined the effects of injustice appraisals in a healthy youth sample by applying a justice violation manipulation. We hypothesized the justice violation condition to lead to worse pain outcomes with effects mediated by anger, sadness, and AB as compared to the control condition. We further explored associations between both baseline and state injustice appraisals and anger, sadness, and AB across conditions. A 2 × 2 time by condition design was used to test hypotheses. 133 healthy youth aged 9-16 years old completed two cold pressor tasks (CPTs). In the experimental (i.e., justice violation) group, participants were initially told to complete one CPT, but were told afterwards to perform it again due to experimenter negligence. In the control group, no justice violation occurred. Baseline injustice appraisals and pain catastrophizing were assessed with the Injustice Experience Questionnaire and Pain Catastrophizing Scale for Children; state outcomes (i.e., injustice, catastrophizing, anger, sadness) were assessed after CPTs. AB was indexed using a dot-probe task. Findings indicated no effects of the justice violation on pain outcomes or associated mechanisms, nor on injustice appraisals, suggesting manipulation failure. However, across conditions, baseline and state injustice appraisals were positively associated with anger and sadness, but not with AB. Despite the experimental justice violation failing to elicit differential injustice appraisals across conditions, the current study supports both anger and sadness as key emotional responses associated with pain-related injustice appraisals in a healthy youth sample.

Preliminary Validation of the Injustice Experience Questionnaire in Patients With Advanced Cancer.

When diagnosed with advanced cancer, patients may perceive their situation as an injustice. The Injustice Experience Questionnaire (IEQ) is a 12-item measure of perceived unfairness originally developed for patients with chronic pain. The factor structure, reliability, and validity of the IEQ in patients with cancer have not been assessed. To examine the factor structure, internal consistency, and construct validity of the IEQ in patients with advanced cancer. Patients with advanced lung or prostate cancer (N = 201) were recruited from academic and public clinics in Indianapolis, IN. Patients completed the 12-item IEQ and other measures of psychological processes and distress. IEQ instructions were modified to focus on cancer-related perceived injustice. Confirmatory factor analysis (CFA) was used to examine the dimensionality of the measure. Internal consistency reliability and construct validity were examined. CFA showed that the original IEQ's 2-factor structure had an adequate fit (RMSEA=0.07, CFI=0.96, SRMR=0.05). The factors included Severity/irreparability and Blame/unfairness. Internal consistency was excellent (α=0.92, ω=0.94). The IEQ showed significant positive associations with physical and psychological symptoms (rs=0.20 - 0.65, Ps < 0.05). The IEQ also showed significant negative associations with quality of life and acceptance of cancer (rs=-0.51 - -0.46, Ps < 0.05). Findings provide preliminary support for using the IEQ in patients with advanced cancer. Future research should assess the sensitivity of the IEQ to change in an interventional context.

Post-Traumatic Trigeminal Neuropathic Pain after Dental Implant Surgery and the Injustice Experience Questionnaire

Painful post-traumatic trigeminal neuropathy (PTTN) is a known complication of dental implant therapy. Patients with PTTN develop sensory abnormalities in the orofacial region, which may be a psychosocial aspect, and dentists should assess somatosensory testing and psychosocial factors. The patients were assessed using quantitative sensory testing (QST). A 64-year-old female presented with allodynia of the left lower lip that occurred after a surgical implant procedure. Persistent pain started 4 months after the placement of two dental implants in the mandible. Sensory testing of these areas revealed warm hyposensitivity and mechanical hypersensitivity of the mandibular region. We also assessed PTTN-related perceived injustice using the Injustice Experience Questionnaire. The patient refused medication therapy such as pregabalin; therefore, autogenic training was adopted as an alternative management strategy. We conclude that for expensive dental procedures, such as implant placement, sufficient consensus should be obtained preoperatively before proceeding with surgery.

Perceived Injustice and Psychological Well-Being in Couples Seeking Fertility Treatment

Infertility and its treatment are associated with a host of negative emotions, including perceived injustice. However, no quantitative study has examined the link between perceived injustice and psychological difficulties in couples seeking fertility treatment. This study examined the associations between perceived injustice and both partners’ psychological well-being and investigated possible differences in perceived injustice based on sex or cause of infertility. Both partners of 103 couples seeking fertility treatment completed the Injustice Experience Questionnaire—Infertility, the Hospital Anxiety and Depression Scale, and the Fertility Quality of Life Tool. Perceived injustice was associated with one’s own and one’s partner’s higher depressive symptoms and lower infertility-related quality of life, as well as one’s own higher anxiety symptoms. Women also perceived more injustice than men. The cause of infertility was unrelated to perceived injustice. Findings suggest that perceived injustice could represent an intervention target to reduce psychological distress in infertile couples.

Perceived Injustice in Patients With Chronic Pain: Prevalence, Relevance, and Associations With Long-Term Recovery and Deterioration

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.

Cross-cultural adaptation and validation of the Hebrew version of the Injustice Experience Questionnaire – long and short versions

Purpose To translate, validate, and culturally adapt the Injustice Experience Questionnaire (IEQ) and IEQ Short Form (IEQ-SF) into Hebrew, as measuring tools for examining feelings of injustice in cases of accidents and chronic pain. Methods The translation was performed in several steps following the cross-cultural adaptation process. A sample of 150 patients suffering from traumatic injury fill out a battery of questionnaires: IEQ, IEQ-SF, Hospital Anxiety and Depression Scale (HADS), Numeric Pain Rating Scale (NPRS), and Pain Catastrophizing Scale (PCS), which were used for calculating construct validity. A test–retest was performed on 41 patients. Results The IEQ and IEQ-SF found Cronbach's alpha of 0.92 and 0.84, respectively. Test–retest reliability for IEQ (ICC: 0.94) was found to be excellent. Spearman’s correlation coefficient between IEQ and PCS was 0.68, NPRS (severe pain: 0.45, average pain: 0.51), HADS (anxiety: 0.62, depression: 0.60). The correlation between IEQ-SF and PCS was 0.67, with HADS (anxiety: 0.52, depression: 0.48). A weak correlation was found for NPRS (severe pain: 0.30, average pain: 0.34). Conclusions The Israeli translation and cross-cultural adaptation of the IEQ and IEQ-SF questionnaires were found to be valid and reliable. Implications for rehabilitation The perception of injustice is a significant mental and psychological factor for recovery after accidents and injuries. This study translated, validated and culturally adapted the Injustice Experience Questionnaire (IEQ) and the short form into Hebrew. The questionnaires were found to be valid and reliable in Hebrew.

Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors.

Background: Chronic pain is a complex biopsychosocial phenomenon. Lifestyle, behavioral, socioeconomic, and psychosocial factors such as depression and perceived injustice are often associated with the development of chronic pain and vice versa. We sought to examine the interaction of these factors with opioid intake. Methods: At our institution, 164 patients with chronic pain undergoing an interdisciplinary assessment within a three-month period participated in the study and completed the Injustice Experience Questionnaire (IEQ). Data regarding opioid intake, pain levels, pain diagnosis, depression, anxiety, stress, quality of life, pain-related disability, habitual well-being, occupational status, and ongoing workers compensation litigation were extracted from the patients’ charts. Results: Approximately one-fourth of the patients used opioids. The IEQ total was significantly higher in patients using Schedule III opioids. Depression, but not the anxiety and stress scores, were significantly higher in patients using opioids. There were no significant differences regarding pain-related disability, habitual well-being, and the coded psychosocial diagnoses. In the patient group without opioids, the percentage of employed persons was significantly higher but there were no significant differences regarding work leave, pension application, or professional education. Conclusions: Opioid use appears to be more closely related to psychological factors and single social determinants of pain than to somatic factors.

Translation and validation of the Norwegian version of the Injustice Experience Questionnaire.

Perceived injustice is a theoretical construct comprising elements of loss, attribution of blame, and sense of unfairness. Patients with chronic pain often report high levels of perceived injustice, which can have negative impact on physiological and psychosocial aspects and treatment outcome. The Injustice Experience Questionnaire (IEQ) is a self-report 12-item questionnaire that shows good reliability and validity in patients with chronic pain. This study aimed to translate, validate, and expand the useof the Norwegian Injustice Experience Questionnaire (IEQ-N) to a chronic pain population. A mixed-method approach was used to translate and validate the IEQ-N. It was forward-back translated, linguistically validated, and culturally adapted. Individual cognitive debriefing interviews (n=7) and a focus group interview (n=9) was used to explore the patients' experience with- and understanding of the questionnaire. Statistical descriptive, correlational, factor- and regression analyses were used to investigate the IEQ-N validity, reliability, and factorial structure in a large registry sample (n=3,068) of patients with chronic pain. Patients with chronic pain found the IEQ-N relevant. Registry analyses supported that the IEQ-N had a one-factor structure. The internal consistency was high (Chronbach's alpha=0.92). The construct validity was good, with moderate to strong significant univariate correlation (r=0.29-0.71) (p<0.05) between perceived injustice and related constructs of pain catastrophizing, pain severity, disability, psychological distress, and quality of life. Perceived injustice contributed with significant but small unique variance to pain-related factors (i.e.,pain intensity, pain-related disability, psychological distress), but the additional contribution beyond pain catastrophizing was small (0.2-6.7%) (p<0.05). Patients in the study found the questionnaire relevant for their situation, and easy to understand. This study provides a reliable and valid Norwegian tool to assess perceived injustice in patients with chronic pain. REK sør-øst, 2016/1942.

Injustice Through Cultural Lens: A Pilot Qualitative Exploration of Pain-Related Injustice Appraisals Among Arab-Americans with Chronic Low Back Pain

The current qualitative study sought to obtain an in-depth understanding of how Arab-Americans conceptualize perceived injustice concerning their chronic low back pain (CLBP) by reflecting on the Injustice Experience Questionnaire (IEQ). Twelve Arab-American adults with CLBP were recruited from a metropolitan area in Alabama using a purposive sampling technique. Participants took part in individual, face-to-face, semi-structured interviews reflecting on each statement from the IEQ. Descriptive data analysis was generated for demographic and pain variables. Directed content analysis was conducted to identify themes and sub-themes. ‘Blame and unfairness’ and ‘severity and irreparability of loss,’ the 2 established theoretical factors comprising pain-related injustice appraisal were used as predominant themes. Acceptance emerged as an inductive theme with the following sub-themes: positive appraisal and resilience, attempts to reduce pain, religious values and fate, and belief that everything happening for a reason. The influence of religion was noted across all themes. The current pilot findings suggest that Arabic culture, heavily infused with Islamic beliefs, influences how Arab-Americans conceptualize pain-related injustice appraisals. Additional exploration of the cultural appropriateness of the IEQ among individuals of Arab background is needed to further elaborate on the subject of faith and religious belief suggested by the current study.Perspective: Although the study findings largely reflected established injustice literature constructs, several emergent themes regarding pain-related injustice appraisal were influenced by the participants’ culture and religious beliefs. These findings may indicate that specific psychotherapeutic approaches that have been proven effective among some groups may not function similarly in other populations.

Teachers' mental health during the first two waves of the COVID-19 pandemic in Poland.

BackgroundTeaching work is stressful, moreover during the pandemic teachers’ stress might have been intensified by distance education as well as by limited access to social support, which functions as a buffer in experiencing stress. The aim of the research was to investigate the relation between distance education and teachers’ well-being, and their close relations and other social relations during the first two waves of the COVID-19 pandemic.MethodsThe research was conducted in two stages on 285 Polish primary and secondary school teachers who were recruited by means of the chain referral method. The following measures were used: The Depression Anxiety & Stress Scales-21, Berlin Social Support Scales, The Relationship Satisfaction Scale and The Injustice Experience Questionnaire.ResultsThe teachers experienced at least mild levels of stress, anxiety and depression, both during the first as well as the second waves of the COVID-19 pandemic in Poland. It has been confirmed that there is a negative relation between relationship quality change and social relations quality change, and stress, anxiety and depression. The variables taken into consideration in the research have provided the explanation for the variation of stress—from 6% in the first stage of the research to 47% in the second stage; for the variation of anxiety—from 21% to 31%; and for the variation of depression—from 12% to 46%, respectively.ConclusionsThe research results show that due to distance work the distinction between professional work and family life might have been blurred, and as a consequence teachers’ well-being could have been worsened. The isolation put on to stop the spreading of the virus might have contributed to changes in social relations, in close relations in particular, and at the same time negatively influenced teachers’ abilities to effectively cope with the crisis situations.

Perceived injustice in multiple sclerosis: An initial, exploratory study.

The current study represents an initial examination of condition-related perceived injustice (PI) in multiple sclerosis (MS) by examining (a) the structural validity and reliability of the Injustice Experience Questionnaire (IEQ) scores and (b) the associations between IEQ scores and scores from measures of anger, pain, depression, anxiety, fatigue, disability, health-related quality of life (HRQOL), physical activity, and sedentary behavior. Research Method/Design: Persons with MS were recruited through the distribution of letters to a random sample of 1,000 persons from the North American Research Committee on MS registry. Participants who completed the IEQ (N = 139) were included in this analysis. Our results support the structural validity of the 2-factor model of Severity/Irreparability and Blame/Unfairness subscales with a Cronbach's alpha of .917 for the overall scale, and values of .857 and .889 for the subscales, respectively. All measures were meaningfully correlated with IEQ scores. Pain (ρ = .466), fatigue (ρ = .430), disability (ρ = .416), walking impairment (ρ = .446), and physical HRQOL (ρ = .624) were strongly correlated with Severity/Irreparability. Anger; however, was strongly correlated with Blame/Unfairness (ρ = .437). Physical activity and sedentary behavior were similarly correlated with the 2 subscales; however, both moderate-to-vigorous (ρ = -.332) and light physical activity (ρ = -.275) were slightly more correlated with Severity/Irreparability. The IEQ is a reliable and valid measure of PI in MS. Physical manifestations of MS are primarily associated with PI, and negative associations were observed between physical activity and IEQ scores. Physical activity may increase self-efficacy and counteract cognitions of permanent disability and frustration concerning limitations that are associated with PI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric assessment of the Swedish version of the injustice experience questionnaire among patients with chronic pain.

The use of the Injustice Experience Questionnaire (IEQ) in psychological assessment of individuals with chronic pain is supported by research. The psychometric properties of the Swedish version, the IEQ-S, has not yet been evaluated. Hence, the aim was to investigate structural validity, and concurrent criterion validity of the IEQ-S against the Work Ability Index (WAI), the Pain Catastrophizing Scale (PCS-SW), the Patient Health Questionnaire 9-item depression module (PHQ-9), and the Generalized anxiety disorder 7-item scale (GAD-7). Internal consistency and test-retest reliability were also studied. Sixty-five participants, referred to a University hospital, with a pain duration over three months were consecutively sampled. They completed the IEQ-S at admission and again within six weeks. A confirmatory factor analysis was performed for the study of structural validity. Concurrent criterion validity was evaluated using Spearman's correlation coefficient. Internal consistency reliability for the full IEQ-S was calculated using the Cronbach's alpha. Test-retest reliability was calculated using an Intraclass Correlation Coefficient (ICC). The median total score (0-48, where high scores indicate high levels of injustice) at admission (test 1) was 27.0 (n=64), 25th percentile=15.3, 75th percentile=37.8, range=3-48 points. A one-factor model was supported with item-loadings between 0.67-0.92. Spearman's correlation coefficient between the IEQ-S and the WAI (n=56) was rS =-0.46; the PCS-SW (n=63) was rS =0.68, the PHQ-9 (n=64) was rS =0.50 and the GAD-7 (n=64) was rS =0.57, p<0.01. Cronbach's alpha was 0.94 (n=64). The ICC was 0.80 (n=55), with a 95% confidence interval, ranging between 0.69-0.88. Our study supported structural validity and concurrent criterion validity of the IEQ-S against other measures of psychological constructs and work ability. It also supported the internal consistency reliability of the IEQ-S and the test-retest reliability with a retest interval up to six weeks, was good. These findings support the use of the IEQ-S as an adjunct tool to assess appraisals of injustice in patients with chronic pain who are referred to tertiary care in Sweden. The added value might be identification of those who are at risk for slow or no improvement in their pain condition over time, and sick-leave, but this has to be confirmed in future studies. EPN Uppsala D-No 2016-376.

Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice

The presence of pain decreases survival rates in cancer. Pain management in clinical settings is often suboptimal and secondary to other cancer-related treatments, leaving many people undertreated. Opioid use is associated with side effects and decreased survival rate in cancer patients. Hence, there is an urgent need for considering factors such as perceived injustice that sustain post-cancer pain and trigger a behavioral pattern associated with opioid use. Injustice beliefs represent a maladaptive pattern of cognitive appraisal that may be a salient target for improving pain-related coping in these patients. Perceived injustice is associated with increased opioid prescription and prospectively predicted opioid use at 1-year follow-up, urging the need for targeted interventions to diminish perceived injustice. Explain the importance of screening for perceived injustice in patients with pain following cancer treatment, its potential relevance for opioid abuse, and its potential impact on the management of pain following cancer. Also, prove clinicians with a clinical guide for an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions to account for perceived injustice in patients having pain following cancer. A narrative review, perspective and treatment manual. Several universities, a university of applied science department, a university hospital, and a private clinic (i.e., transdisciplinary pain treatment center). Patients were cancer survivors with pain. Intervention included modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. Measurements were taken through the Injustice Experience Questionnaire (IEQ). The IEQ can be used to assess perceived injustice in a valid way. Education about pain, including discussing perceived injustice, should be the first part of the management of pain in cancer survivors. In order to obtain the often-required behavioral change towards a more adaptive lifestyle, motivational interviewing can be used. To thoroughly tackle perceived injustice in patients having pain following cancer, special emphasis should be given to the individual reasons patients identify for experiencing (continued) pain and related symptoms. Pain acceptance should also be thoroughly addressed. Clinical trials exploring the benefits, including cost-effectiveness, of such a multimodal approach in patients with pain following cancer treatment are needed. In light of its potential relevance for opioid abuse and potential impact on conservative management strategies, clinicians are advised to screen for perceived injustice in patients with pain following cancer treatment. Therapeutic targeting of perceived injustice can be done through an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions.

Perceived Injustice After Mild Traumatic Brain Injury.

Objective:To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI).Design:Observational study.Setting:TBI outpatient unit.Participants:Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34).Main Measures:The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory–Second Edition (BDI-II), PTSD Checklist–Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected.Results:Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance.Conclusions:Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.

Validation of the Injustice Experience Questionnaire (IEQ) in a spinal cord injury population.

Retrospective analysis of cross-sectional data. To verify the factor structure of the Injustice Experience Questionnaire (IEQ) using a sample of individuals with spinal cord injury (SCI) and to assess IEQ scale reliability and construct validity using the same population. Two SCI rehabilitation sites in the United States. Three datasets were combined to conduct this validation study. The sample consisted of 341 adults with SCI who completed the IEQ, measures of psychological distress and pain, and provided sociodemographic and injury-related information. A series of confirmatory factor analyses (CFA) and exploratory factor analyses (EFA) were conducted to verify the two-factor structure of the IEQ, Cronbach's alpha was used to demonstrate scale reliability, and correlations between the IEQ and measures of pain and psychological distress were examined to assess construct validity. Poor model fit was observed for the two-factor structure of the IEQ as well as for the subsequent factor-structures that were explored. The IEQ demonstrated strong scale reliability (α = 0.89) and correlations between the IEQ and measures of pain and psychological distress were in the expected direction, indicating good construct validity. In this preliminary validation study, we failed to confirm the two-factor structure of the IEQ in a population of individuals with SCI. Though good scale reliability and construct validity were observed, further study is needed to refine the IEQ for use in this population.