Perceived Injustice (PI), Persistent Pain & Disability: A Must Read!!

Reference:1. Sullivan MJ, et al. The role of perceived injustice in the experience of chronic pain and disability: scale development and validation. J Occup Rehabil. 2008 Sep;18(3):249-61. Epub 2008 Jun 7. 2. Sullivan MJ, Thibault P, Simmonds MJ, Milioto M, Cantin AP, Velly AM. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain. 2009 Oct;145(3):325-31.

We are all aware that patients coping with persistent pain suffer from more than just “pain”. They often also have to deal with potential unemployment, financial stresses, anger and even litigation.

These 2 truly fascinating studies on Perceived Injustice (PI) demonstrate that “suffering” is unfortunately magnified when patients perceive themselves as a “victim”, especially if the injury has occurred as a result of another’s fault or carelessness.

The first study followed patients with whiplash injuries, and concluded that pain catastrophizing and perceived injustice (PI) were the most significant risk factors for the development of chronic pain.

The second study followed individuals post MVA and post work related injuries, and here is the summary…

Conclusion #1: Men had higher scores of PI than women (…why would men seek ‘to blame’ more than women?)

Conclusion #2: Patients with injuries related to MVAs had higher scores of PI than those with work related injuries (…perhaps it is simply easier to identify who’s at fault with an MVA!)

Conclusion #3: PI was significantly correlated with pain severity, catastrophizing, disability and even depression.

Conclusion#4: PI was the best predictor of functional & work disability at 1- year follow-up (…perhaps due to greater focus on pain, loss, and the desperate need to prove ones disability!)

Other studies have shown the following…

1) Perceived injustice can increase anger and the focus to ‘right the wrong’
2) Anger has been associated with more intense pain and severe disability
3) Perceived injustice increases focus on ‘revenge’ and justice which further fuels anger

(especially when pending litigations or claims may maintain disability in order to maximize settling of scores for losses)

Having said all this, there are of course many situations where the perceptions of injustice may be perfectly justified; e.g. being injured by a drunk driver or unsafe work conditions …but do these thoughts actually help recovery???

The answer is clearly, no! It is suggested that early interventions for targeting perceptions of catastrophization and injustice may be essential for more rapid functional recovery following traumatic injuries.

Posted on: April 15, 2011

Categories: Fascinating Pain Studies

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