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

Abstract

Objectives: 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. Materials and Methods: 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: 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. Discussion: 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.

Relations of perceived injustice to psycho‐spiritual outcomes in advanced lung and prostate cancer: Examining the role of acceptance and meaning making

“…Our results suggest that acceptance of cancer may be a mediating process between perceived injustice and psycho‐spiritual outcomes. Similar results were found for people with chronic pain; greater perceived injustice was associated with lower pain acceptance, which, in turn, was associated with poorer psychological outcomes 24 . Results are consistent with conceptualizing acceptance as a coping strategy by which patients come to terms with their illness and its perceived unfairness, resulting in worse psycho‐spiritual outcomes 22 .…”

“…greater perceived injustice was associated with lower pain acceptance, which, in turn, was associated with poorer psychological outcomes. 24 Results are consistent with conceptualizing acceptance as a coping strategy by which patients come to terms with their illness and its perceived unfairness, resulting in worse psycho-spiritual outcomes. 22 Conversely, patients with elevated perceived injustice may be less able to make peace with their illness and engage in meaningful activities despite their illness.…”

“…When cancer is perceived as an injustice, patients may struggle to find meaning in their experience and accept their situation, resulting in poor psycho‐spiritual outcomes. Although research has not examined these proposed relations in cancer patients, reduced pain acceptance has mediated the positive relationships between perceived injustice and psychological outcomes (e.g., anger, depressive symptoms) in patients with chronic pain 17,24 …”

“…Although research has not examined these proposed relations in cancer patients, reduced pain acceptance has mediated the positive relationships between perceived injustice and psychological outcomes (e.g., anger, depressive symptoms) in patients with chronic pain. 17,24 The present study tested a model of the relationships between perceived injustice and psycho-spiritual outcomes in advanced lung and prostate cancer patients. We focused on these patient groups because of the high prevalence of these cancers and associated poor psycho-spiritual outcomes.…”

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

“…Correlation statistics also confirm this assumption, as there is a significant correlation between PI and these factors. Previous research found the same positive association between pain intensity and the level of PI in different populations, such as chronic pain [13,25,36,37,54,[60][61][62][63][64][65][66][67][68][69][70], low back pain [66,71,72], traumatic injuries [67,[73][74][75][76][77], menstrual pain [78], whiplash injury [26,52,79], spinal cord injury (SCI) [80], arthritis and fibromyalgia [27,81], and breast cancer survivors [9,11]. As mentioned before, the increased pain behavior seen in people with PI results in a more intense feeling of suffering and loss [82].…”