Perceived Injustice is Associated with Heightened Pain Behavior and Disability in Individuals with Whiplash Injuries

Abstract

The present study examined the relationship between perceived injustice associated with whiplash injury and displays of pain behavior. Individuals (N=85) with whiplash injuries were filmed while performing a simulated occupational lifting task. They were also asked to complete measures of pain, perceived injustice, catastrophic thinking, depression, and functional disability. Consistent with previous research, high levels of perceived injustice were associated with more intense pain, higher levels of catastrophic thinking, depression, and disability. Analyses revealed that individuals with high levels of perceived injustice displayed more protective pain behaviors than individuals with low levels of perceived injustice, regardless of the level of physical demand of the task. The relation between perceived injustice and protective pain behavior remained significant even when controlling for pain severity, catastrophic thinking, and depression. There was no significant association between perceived injustice and displays of communicative pain behavior. The results of this study suggest that the relation between perceived injustice and pain behavior might underlie the high prevalence of occupational disability in individuals who have sustained whiplash injuries. Implications for intervention are addressed.

The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample

“…Accordingly, our findings extend the growing body of research regarding known correlates of perceived injustice. Given the previously demonstrated associations between perceived injustice and variables associated with pain and disability (including pain catastrophizing and pain-related fear [26,38,39,41]), this finding is perhaps not surprising, as these constructs/cognitions also show association with AB (e.g., [1,18,45,56]). Although this was not directly assessed in the current study, it is important to note that previous research acknowledges some overlap between perceived injustice and pain catastrophizing [38]; however, perceived injustice has been conceptualized (and supported) as a distinct construct reflecting elements of blame and anger, which are not captured by pain catastrophizing [29,38,55].…”

“…However, in contrast to these studies, no association was observed between perceived injustice and pain intensity ratings; the effect was confined to ratings of anger and sadness. With respect to ratings of sadness, the association between perceived injustice and depression is well documented [26,30,31,38,39,41]. Further, a recent study by Scott and colleagues pointed to the association of perceived injustice with various indices of anger [31].…”

“…Pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain-or injury-related loss, externalized blame, and unfairness [37,38]. Outcomes associated with elevated injustice perception have included greater self-reported pain and disability [32,37], higher pain behavior [39], and poorer outcomes following rehabilitation treatment [38] and expression of pain; or (3) a high facial expression of pain. The selection of different pain expression levels allowed us to examine whether AB in relation to perceived injustice is moderated by varying levels of pain expressiveness.…”

Determining Disability: New Advances in Conceptualization and Research

“…First, Franche et al (2009) present research on the development of an assessment tool of perceived injustice and the relationship of scores obtained with the instrument to heightened pain behavior and disability. Second, Sullivan et al (2009) undertook empirical investigation of the pain elicited by putting forth effort on physical tasks and scores on a different scale of perceived injustice. Third, in a legal paper, Hayman (2009) explores jurisprudence and emerging legal issues related to damages for mental distress and bad faith in disability claims.…”

“…The study by Sullivan et al (2009) uses a different measure of perceived justice and reveals that individuals with elevated levels of perceived injustice displayed more protective pain behaviors than individuals with low levels of perceived injustice, regardless of physical task demands. Like Franche et al (2009), the authors of this study postulate the importance of evaluating perceived injustice as one of the key predictors of disability and potential targets for interventions.…”