Background Research among adult and paediatric samples suggests that pain‐related injustice appraisals contribute to adverse pain‐related functioning. However, a singular focus on pain‐related injustice appraisals carries the risk of underestimating the role of broader concepts of justice. This study examined the unique roles of child pain‐related injustice appraisals and just‐world beliefs in understanding disability and physical, emotional, social and academic functioning, as well as the mediating role of injustice appraisals in the relationship between just‐world beliefs and functioning. Methods Participants comprised a school sample of 2,174 children (Study 1) and a clinical sample of 146 paediatric chronic pain patients (Study 2) who completed the Injustice Experience Questionnaire (IEQ), Personal and General Belief in a Just World scales (JWB‐P/G), Functional Disability Inventory (FDI), Pain Catastrophizing Scale for Children (PCS‐C) and Pediatric Quality of Life Inventory (PEDSQL). Results For both samples, child pain‐related injustice appraisals were associated with poorer functioning, after controlling for just‐world beliefs, catastrophizing, pain intensity, age and sex. In the school sample, injustice appraisals mediated the associations of both personal and general just‐world beliefs with functioning. In the clinical sample, injustice appraisals mediated the association of personal, but not general, just‐world beliefs with all functioning scales. Conclusions The current findings attest to the unique role of pain‐related injustice appraisals in understanding child pain‐related functioning and their explanatory value in understanding the relationship between fundamental just‐world beliefs and child pain‐related functioning. Significance The present study adds to emerging literature on the adverse effects of child pain‐related injustice appraisals in the context of pain, through showing that pain‐related injustice appraisals are uniquely associated with pain‐related functioning and mediate the relationship between just‐world beliefs and pain‐related functioning. These findings suggest that interventions may target pain‐related injustice appraisals as a mechanism for change in children.

BackgroundYouth 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.MethodsA 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.ResultsFindings 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.ConclusionsDespite 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.