Advertisement

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

Published:August 21, 2016DOI:https://doi.org/10.1016/j.jpain.2016.08.001

      Highlights

      • The study included individuals with chronic low back pain.
      • Perceived injustice, attentional bias (AB), and activity appraisals were assessed.
      • Perceived injustice was positively associated with attention bias to pain.
      • Perceived injustice and AB were positively associated with pain and difficulty appraisals.
      • AB did not mediate the relationship between perceived injustice and task appraisals.

      Abstract

      The current study examined the relationship between perceived injustice and attentional bias (AB) toward pain among individuals with chronic low back pain asked to perform and appraise the pain and difficulty of a standardized set of common physical activities. A pictorial dot-probe task assessed AB toward pain stimuli (ie, pain faces cueing pain), after which participants performed the physical tasks. Participants also rated face stimuli in terms of pain, sadness, and anger expression. As hypothesized, perceived injustice was positively associated with AB toward pain stimuli; additionally, perceived injustice and AB were positively associated with appraisals of pain and difficulty. Counter to expectations, AB did not mediate the relationship between perceived injustice and task appraisals, suggesting that AB is insufficient to explain this relationship. Exploratory analyses indicated that participants with higher levels of perceived injustice rated stimulus faces as sadder and angrier; no such differences emerged for pain ratings. To our knowledge, this is the first study to examine the association between perceived injustice and AB toward pain, as well as perceived injustice and in vivo appraisals of common physical activity. Results extend existing literature and suggest that attentional and potential interpretive bias should be considered in future research.

      Perspective

      This article identifies significant associations between perceived injustice, biased attention to pain, and appraisals of common physical activities among individuals with chronic low back pain. These findings suggest targets for intervention as well as directions for future research regarding individuals with high perceptions of injustice related to pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Asmundson G.J.
        • Carleton R.N.
        • Ekong J.
        Dot-probe evaluation of selective attentional processing of pain cues in patients with chronic headaches.
        Pain. 2005; 114: 250-256
        • Cano A.
        Pain catastrophizing and social support in married individuals with chronic pain: The moderating role of pain duration.
        Pain. 2004; 110: 656-664
        • Cano A.
        • Leong L.
        • Heller J.B.
        • Lutz J.R.
        Perceived entitlement to pain-related support and pain catastrophizing: Associations with perceived and observed support.
        Pain. 2009; 147: 249-254
        • Chapman S.
        • Martin M.
        Attention to pain words in irritable bowel syndrome: Increased orienting and speeded engagement.
        Br J Health Psychol. 2011; 16: 47-60
        • Crombez G.
        • Van Ryckeghem D.M.
        • Eccleston C.
        • Van Damme S.
        Attentional bias to pain-related information: A meta-analysis.
        Pain. 2013; 154: 497-510
        • Dear B.F.
        • Sharpe L.
        • Nicholas M.
        • Refshauge K.
        The psychometric properties of the dot-probe paradigm when used in pain-related attentional bias research.
        J Pain. 2011; 12: 1247-1254
        • De Clercq A.
        • Crombez G.
        • Buysse A.
        • Roeyers H.
        A simple and sensitive method to measure timing accuracy.
        Behav Res Methods Instrum Comput. 2003; 35: 109-115
        • De Ruddere L.
        • Goubert L.
        • Prkachin K.M.
        • Stevens M.A.
        • Van Ryckeghem D.M.
        • Crombez G.
        When you dislike patients, pain is taken less seriously.
        Pain. 2011; 152: 2342-2347
        • De Ruddere L.
        • Goubert L.
        • Stevens M.A.
        • Deveugele M.
        • Craig K.D.
        • Crombez G.
        Health care professionals’ reactions to patient pain: Impact of knowledge about medical evidence and psychosocial influences.
        J Pain. 2014; 15: 262-270
        • De Ruddere L.
        • Goubert L.
        • Vervoort T.
        • Kappesser J.
        • Crombez G.
        Impact of being primed with social deception upon observer responses to others’ pain.
        Pain. 2013; 154: 221-226
        • Eccleston C.
        • Crombez G.
        Pain demands attention: A cognitive-affective model of the interruptive function of pain.
        Psychol Bull. 1999; 125: 356-366
      1. FACS Manual. Available at: http://www.paulekman.com/product/facs-manual. Accessed February 18, 2016

        • Ferrari R.
        • Russell A.S.
        Perceived injustice in fibromyalgia and rheumatoid arthritis.
        Clin Rheumatol. 2014; 33: 1501-1507
        • Goubert L.
        • Vervoort T.
        • Cano A.
        • Crombez G.
        Catastrophizing about their children’s pain is related to higher parent-child congruency in pain ratings: An experimental investigation.
        Eur J Pain. 2009; 13: 196-201
        • Hayes A.F.
        Beyond Baron and Kenny: Statistical mediation analysis in the new millennium.
        Commun Monogr. 2009; 76: 408-420
        • Hill M.L.
        • Craig K.D.
        Detecting deception in pain expressions: The structure of genuine and deceptive facial displays.
        Pain. 2002; 98: 135-144
        • Holmbeck G.N.
        Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations.
        J Ped Psychol. 2002; 27: 87-96
        • Keogh E.
        • Cochrane M.
        Anxiety sensitivity, cognitive biases, and the experience of pain.
        J Pain. 2002; 3: 320-329
        • Kool M.B.
        • van de Schoot R.
        • López-Chicheri García I.
        • Mewes R.
        • Da Silva J.A.
        • Vangronsveld K.
        • Wismeijer A.A.
        • Lumley M.A.
        • van Middendorp H.
        • Bijlsma J.W.
        • Crombez G.
        • Rief W.
        • Geenen R.
        Measurement invariance of the Illness Invalidation Inventory (3*I) across language, rheumatic disease and gender.
        Ann Rheum Dis. 2014; 73: 551-556
        • Koster E.H.
        • Crombez G.
        • Verschuere B.
        • De Houwer J.
        Selective attention to threat in the dot probe paradigm: Differentiating vigilance and difficulty to disengage.
        Behav Res Ther. 2004; 42: 1183-1192
        • Liossi C.
        • White P.
        • Schoth D.E.
        Time-course of attentional bias for threat-related cues in patients with chronic daily headache-tension type: Evidence for the role of anger.
        Eur J Pain. 2011; 15: 92-98
        • Monden K.M.
        • Trost Z.
        • Scott W.
        • Bogart K.R.
        • Driver S.
        The unfairness of it all: Exploring the role of injustice appraisals in rehabilitation outcome.
        Rehab Pscyhol. 2016; 61: 44-53
        • Preacher K.J.
        • Hayes A.F.
        SPSS and SAS procedures for estimating indirect effects in simple mediation models.
        Behav Res Methods Instrum Comput. 2004; 36: 717-731
        • Priebe J.A.
        • Messingschlager M.
        • Lautenbacher S.
        Gaze behaviour when monitoring pain faces: An eye-tracking study.
        Eur J Pain. 2015; 19: 817-825
        • Prkachin K.M.
        • Schultz I.
        • Berkowitz J.
        • Hughes E.
        • Hunt D.
        Assessing pain behaviour of low-back pain patients in real time: Concurrent validity and examiner sensitivity.
        Behav Res Ther. 2002; 40: 595-607
        • Rodero B.
        • Luciano J.V.
        • Montero-Marin J.
        • Casanueva B.
        • Palacin J.C.
        • Gili M.
        • del Hoyo Y.L.
        • Serrano-Blanco A.
        • Garcia-Campayo J.
        Perceived injustice in fibromyalgia: Psychometric characteristics of the Injustice Experience Questionnaire and relationship with pain catastrophising and pain acceptance.
        J Psychosom Res. 2012; 73: 86-91
        • Roelofs J.
        • Peters M.L.
        • Patijn J.
        • Schouten E.G.
        • Vlaeyen J.W.
        Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.
        Pain. 2004; 112: 335-342
        • Schrooten M.G.
        • Van Damme S.
        • Crombez G.
        • Peters M.L.
        • Vogt J.
        • Vlaeyen J.W.
        Nonpain goal pursuit inhibits attentional bias to pain.
        Pain. 2012; 153: 1180-1186
        • Scott W.
        • Sullivan M.
        Perceived injustice moderates the relationship between pain and depressive symptoms among individuals with persistent musculoskeletal pain.
        Pain Res Manage. 2012; 17: 335-340
        • Scott W.
        • Trost Z.
        • Bernier E.
        • Sullivan M.J.
        Anger differentially mediates the relationship between perceived injustice and chronic pain outcomes.
        Pain. 2013; 154: 1691-1698
        • Scott W.
        • Trost Z.
        • Milioto M.
        • Sullivan M.J.
        Further validation of a measure of injury-related injustice perceptions to identify risk for occupational disability: A prospective study of individuals with whiplash injury.
        J Occup Rehabil. 2013; 23: 557-565
        • Sharpe L.
        • Haggman S.
        • Nicholas M.
        • Dear B.F.
        • Refshauge K.
        Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain.
        Pain. 2014; 155: 45-52
        • Sharpe L.
        • Ianiello M.
        • Dear B.F.
        • Nicholson Perry K.
        • Refshauge K.
        • Nicholas M.K.
        Is there a potential role for attention bias modification in pain patients? Results of 2 randomised, controlled trials.
        Pain. 2012; 153: 722-731
        • Simon D.
        • Craig K.D.
        • Gosselin F.
        • Belin P.
        • Rainville P.
        Recognition and discrimination of prototypical dynamic expressions of pain and emotions.
        Pain. 2008; 135: 55-64
        • Sullivan M.J.
        • Adams H.
        • Horan S.
        • Maher D.
        • Boland D.
        • Gross R.
        The role of perceived injustice in the experience of chronic pain and disability: Scale development and validation.
        J Occup Rehabil. 2008; 18: 249-261
        • Sullivan M.J.
        • Adams H.
        • Martel M.O.
        • Scott W.
        • Wideman T.
        Catastrophizing and perceived injustice: Risk factors for the transition to chronicity after whiplash injury.
        Spine. 2011; 36: S244
        • Sullivan M.J.
        • Davidson N.
        • Garfinkel B.
        • Siriapaipant N.
        • Scott W.
        Perceived injustice is associated with heightened pain behavior and disability in individuals with whiplash injuries.
        Psychol Inj Law. 2009; 2: 238-247
        • Sullivan M.J.
        • Martel M.O.
        • Tripp D.A.
        • Savard A.
        • Crombez G.
        Catastrophic thinking and heightened perception of pain in others.
        Pain. 2006; 123: 37-44
        • Sullivan M.J.
        • Scott W.
        • Trost Z.
        Perceived injustice: A risk factor for problematic pain outcomes.
        Clin J Pain. 2012; 28: 484-488
        • Sullivan M.J.
        • Thibault P.
        • Simmonds M.J.
        • Milioto M.
        • Cantin A.P.
        • Velly A.M.
        Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries.
        Pain. 2009; 145: 325-331
        • Todd J.
        • Sharpe L.
        • Johnson A.
        • Nicholson Perry K.
        • Colagiuri B.
        • Dear B.F.
        Towards a new model of attentional biases in the development, maintenance, and management of pain.
        Pain. 2015; 156: 1589-1600
        • Trost Z.
        • Agtarap S.
        • Scott W.
        • Driver S.
        • Guck A.
        • Roden-Foreman K.
        • Reynolds M.
        • Foreman M.L.
        • Warren A.M.
        Perceived injustice after traumatic injury: Associations with pain, psychological distress, and quality of life outcomes 12 months after injury.
        Rehabil Psychol. 2015; 60: 213-221
        • Trost Z.
        • Vangronsveld K.
        • Linton S.J.
        • Quartana P.J.
        • Sullivan M.J.
        Cognitive dimensions of anger in chronic pain.
        Pain. 2012; 153: 515-517
        • Van Damme S.
        • Crombez G.
        • Eccleston C.
        Disengagement from pain: The role of catastrophic thinking about pain.
        Pain. 2004; 107: 70-76
        • Van Damme S.
        • Crombez G.
        • Notebaert L.
        Attentional bias to threat: A perceptual accuracy approach.
        Emotion. 2008; 8: 820-827
        • Van Ryckeghem D.
        • Crombez G.
        Attentional bias and chronic pain: Where to go from here?.
        Pain. 2014; 155: 6-7
        • Van Ryckeghem D.M.
        • Crombez G.
        • Goubert L.
        • De Houwer J.
        • Onraedt T.
        • Van Damme S.
        The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study.
        Pain. 2013; 154: 468-475
        • Van Ryckeghem D.M.
        • Crombez G.
        • Van Hulle L.
        • Van Damme S.
        Attentional bias towards pain-related information diminishes the efficacy of distraction.
        Pain. 2012; 153: 2345-2351
        • Vervoort T.
        • Caes L.
        • Crombez G.
        • Koster E.
        • Van Damme S.
        • Dewitte M.
        • Goubert L.
        Parental catastrophizing about children’s pain and selective attention to varying levels of facial expression of pain in children: A dot-probe study.
        Pain. 2011; 152: 1751-1757
        • Vervoort T.
        • Caes L.
        • Trost Z.
        • Notebaert L.
        • Goubert L.
        Parental attention to their child’s pain is modulated by threat-value of pain.
        Health Psychol. 2012; 31: 623-631
        • Vervoort T.
        • Trost Z.
        • Prkachin K.M.
        • Mueller S.C.
        Attentional processing of other’s facial display of pain: An eye tracking study.
        Pain. 2013; 154: 836-844
        • Vervoort T.
        • Trost Z.
        • Van Ryckeghem D.M.
        Children’s selective attention to pain and avoidance behaviour: The role of child and parental catastrophizing about pain.
        Pain. 2013; 154: 1979-1988
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Yakobov E.
        • Scott W.
        • Stanish W.
        • Dunbar M.
        • Richardson G.
        • Sullivan M.
        The role of perceived injustice in the prediction of pain and function after total knee arthroplasty.
        Pain. 2014; 155: 2040-2046
        • Yang Z.
        • Jackson T.
        • Gao X.
        • Chen H.
        Identifying selective visual attention biases related to fear of pain by tracking eye movements within a dot-probe paradigm.
        Pain. 2012; 153: 1742-1748