Advertisement

Perceived Injustice Is Associated With Pain and Functional Outcomes in Children and Adolescents With Chronic Pain: A Preliminary Examination

Published:August 21, 2016DOI:https://doi.org/10.1016/j.jpain.2016.08.002

      Highlights

      • Higher levels of perceived injustice are associated with higher pain intensity.
      • Higher levels of perceived injustice are associated with greater catastrophizing.
      • Higher levels of perceived injustice are associated with poorer functioning.
      • Perceived injustice is predictive of greater pain intensity and catastrophizing.
      • Perceived injustice is predictive of poorer functioning.

      Abstract

      Chronic pain is prevalent in children/adolescents and contributes to high rates of healthcare utilization. Research suggests injustice perceptions about pain are important in adult patients and a possible treatment focus. We conducted a preliminary evaluation of the psychometric properties of the Injustice Experiences Questionnaire (IEQ) and the relationship between injustice perceptions, pain, and functioning in chronic pain patients (N = 139, mean age = 15 years, 72% female) presenting to a pediatric pain clinic. Patients completed measures assessing pain intensity, injustice perceptions about pain, catastrophizing, overall functional disability, emotional functioning, social functioning, and school functioning. The IEQ showed good reliability and validity. Higher levels of perceived injustice were associated with higher levels of pain intensity, catastrophizing, and functional disability, and with poorer emotional, social, and school functioning. Additionally, perceived injustice remained significantly associated with pain intensity, functional disability, emotional functioning, social functioning, and school functioning after accounting for relevant demographic and clinical factors. This is the first study to suggest that injustice perceptions are important in the experience of pediatric chronic pain patients. Future studies should more thoroughly examine the psychometric properties of the IEQ in children/adolescents and elucidate the causal nature of these relationships, which will inform treatment efforts to improve pediatric pain care.

      Perspective

      This initial investigation suggests that injustice perceptions about pain can be reliably and validly measured and are tied to important clinical outcomes in children/adolescents. Future studies that replicate and extend these preliminary results are necessary to determine the extent to which injustice perceptions are an important target for intervention.

      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

        • Abela J.R.
        The hopelessness theory of depression: A test of the diathesis–stress and causal mediation components in third and seventh grade children.
        J Abnorm Child Psychol. 2001; 29: 241-254
        • Asmundson G.J.
        • Noel M.
        • Petter M.
        • Parkerson H.A.
        Pediatric fear-avoidance model of chronic pain: Foundation, application and future directions.
        Pain Res Manag. 2012; 17: 397-405
        • Becker N.
        • Thomsen A.B.
        • Olsen A.K.
        • Sjøgren P.
        • Bech P.
        • Eriksen J.
        Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center.
        Pain. 1997; 73: 393-400
        • Brown G.K.
        A causal analysis of chronic pain and depression.
        J Abnorm Psychol. 1990; 99: 127-137
        • Claar R.L.
        • Walker L.S.
        Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory.
        Pain. 2006; 121: 77-84
        • Comrey A.L.
        • Lee H.B.
        A First Course in Factor Analysis.
        Lawrence Erlbaum Associates, Hillsdale, NJ1992
        • Costenbader V.
        • Markson S.
        School suspension: A study with secondary school students.
        J Sch Psychol. 1998; 36: 59-82
        • Crombez G.
        • Bijttebier P.
        • Eccleston C.
        • Mascagni T.
        • Mertens G.
        • Goubert L.
        • Verstraeten K.
        The child version of the pain catastrophizing scale (PCS-C): A preliminary validation.
        Pain. 2003; 104: 639-646
        • Cronbach L.J.
        Coefficient alpha and the internal structure of tests.
        Psychometrika. 1951; 16: 297-334
        • Fetchenhauer D.
        • Huang X.
        Justice sensitivity and distributive decisions in experimental games.
        J Individ Differ. 2004; 36: 1015-1029
        • Flesch R.
        A new readability yardstick.
        J Appl Psychol. 1948; 32: 221-233
        • Forgeron P.A.
        • King S.
        • Stinson J.N.
        • McGrath P.J.
        • MacDonald A.J.
        • Chambers C.T.
        Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review.
        Pain Res Manag. 2010; 15: 27-41
        • Gauntlett-Gilbert J.
        • Eccleston C.
        Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning.
        Pain. 2007; 131: 132-141
        • Gladstone T.R.
        • Kaslow N.J.
        Depression and attributions in children and adolescents: A meta-analytic review.
        J Abnorm Child Psychol. 1995; 23: 597-606
        • Goubert L.
        • Eccleston C.
        • Vervoort T.
        • Jordan A.
        • Crombez G.
        Parental catastrophizing about their child’s pain. The parent version of the Pain Catastrophizing Scale (PCS-P): A preliminary validation.
        Pain. 2006; 123: 254-263
        • Groenewald C.B.
        • Essner B.S.
        • Wright D.
        • Fesinmeyer M.D.
        • Palermo T.M.
        The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States.
        J Pain. 2014; 15: 925-933
        • Hamlin J.K.
        • Wynn K.
        • Bloom P.
        • Mahajan N.
        How infants and toddlers react to antisocial others.
        Proc Natl Acad Sci U S A. 2011; 108: 19931-19936
        • Huguet A.
        • Miró J.
        The severity of chronic pediatric pain: An epidemiological study.
        J Pain. 2008; 9: 226-236
        • Jacobs J.E.
        • Klaczynski P.A.
        The development of judgment and decision making during childhood and adolescence.
        Curr Dir Psychol Sci. 2002; 11: 145-149
        • Jose P.E.
        Just-world reasoning in children’s immanent justice judgments.
        Child Dev. 1990; 61: 1024-1033
        • Kashikar-Zuck S.
        • Flowers S.R.
        • Claar R.L.
        • Guite J.W.
        • Logan D.E.
        • Lynch-Jordan A.M.
        • Palermo T.M.
        • Wilson A.C.
        Clinical utility and validity of the functional disability inventory among a multicenter sample of youth with chronic pain.
        Pain. 2011; 152: 1600-1607
        • Kashikar-Zuck S.
        • Goldschneider K.R.
        • Powers S.W.
        • Vaught M.H.
        • Hershey A.D.
        Depression and functional disability in chronic pediatric pain.
        Clin J Pain. 2001; 17: 341-349
        • Kashikar-Zuck S.
        • Lynch A.M.
        • Graham T.B.
        • Swain N.F.
        • Mullen S.M.
        • Noll R.B.
        Social functioning and peer relationships of adolescents with juvenile fibromyalgia syndrome.
        Arthritis Rheum. 2007; 57: 474-480
        • Keefe F.J.
        • Lumley M.
        • Anderson T.
        • Lynch T.
        • Carson K.L.
        Pain and emotion: New research directions.
        J Clin Psychol. 2001; 57: 587-607
        • King S.
        • Chambers C.T.
        • Huguet A.
        • MacNevin R.C.
        • McGrath P.J.
        • Parker L.
        • MacDonald A.J.
        The epidemiology of chronic pain in children and adolescents revisited: A systematic review.
        Pain. 2011; 152: 2729-2738
        • Kraha A.
        • Turner H.
        • Nimon K.
        • Zientek L.R.
        • Henson R.K.
        Tools to support interpreting multiple regression in the face of multicollinearity.
        Front Psychol. 2012; 3: 44
        • Logan D.E.
        • Scharff L.
        Relationships between family and parent characteristics and functional abilities in children with recurrent pain syndromes: An investigation of moderating effects on the pathway from pain to disability.
        J Pediatr Psychol. 2005; 30: 698-707
        • Lynch-Jordan A.M.
        • Kashikar-Zuck S.
        • Goldschneider K.R.
        Parent perceptions of adolescent pain expression: The Adolescent Pain Behavior Questionnaire.
        Pain. 2010; 151: 834-842
        • Lynch-Jordan A.M.
        • Kashikar-Zuck S.
        • Szabova A.
        • Goldschneider K.R.
        The interplay of parent and adolescent catastrophizing and its impact on adolescents’ pain, functioning, and pain behavior.
        Clin J Pain. 2013; 29: 681-688
        • McParland J.L.
        • Eccleston C.
        “It’s Not Fair” social justice appraisals in the context of chronic pain.
        Curr Dir Psychol Sci. 2013; 22: 484-489
        • McParland J.
        • Knussen C.
        Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members.
        Eur J Pain. 2010; 14: 71-76
        • McWilliams L.A.
        • Cox B.J.
        • Enns M.W.
        Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample.
        Pain. 2003; 106: 127-133
        • Paananen M.
        • Taimela S.
        • Auvinen J.
        Impact of self-reported musculoskeletal pain on health-related quality of life among young adults.
        Pain Med. 2011; 12: 9-17
        • Palermo T.M.
        Impact of recurrent and chronic pain on child and family daily functioning: A critical review of the literature.
        J Dev Behav Pediatr. 2000; 21: 58-69
        • Palermo T.M.
        • Eccleston C.
        • Lewandowski A.S.
        • Williams A.C.
        • Morley S.
        Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review.
        Pain. 2010; 148: 387-397
        • Peterson C.C.
        • Palermo T.M.
        Parental reinforcement of recurrent pain: The moderating impact of child depression and anxiety on functional disability.
        J Pediatr Psychol. 2004; 29: 331-341
        • Pielech M.
        • Ryan M.
        • Logan D.
        • Kaczynski K.
        • White M.T.
        • Simons L.E.
        Pain catastrophizing in children with chronic pain and their parents: Proposed clinical reference points and reexamination of the Pain Catastrophizing Scale measure.
        Pain. 2014; 155: 2360-2367
        • Powers S.W.
        • Patton S.R.
        • Hommel K.A.
        • Hershey A.D.
        Quality of life in childhood migraines: Clinical impact and comparison to other chronic illnesses.
        Pediatrics. 2003; 112: e1-e5
        • Reid G.L.
        • Lang B.A.
        • McGrath P.J.
        Primary juvenile fibromyalgia: Psychological adjustment, family functioning, coping, and functional disability.
        Arthritis Rheumatol. 1997; 40: 752-760
        • Rhudy J.L.
        • Meagher M.W.
        The role of emotion in pain modulation.
        Curr Opin Psychiatry. 2001; 14: 241-245
        • Rochat P.
        • Dias M.D.
        • Liping G.
        • Broesch T.
        • Passos-Ferreira C.
        • Winning A.
        • Berg B.
        Fairness in distributive justice by 3-and 5-year-olds across seven cultures.
        J Cross Cult Psychol. 2009; 40: 416-442
        • Rodero B.
        • Luciano J.V.
        • Montero-Marin J.
        • Casanueva B.
        • Palacin J.C.
        • Gili M.
        • Lopez del Hoyo Y.
        • Serrano-Blanco A.
        • Garcia-Campayo J.
        Perceived injustice in fibromyalgia: Psychometric characteristic of the Injustice Experience Questionnaire and relationship with pain catastrophizing and pain acceptance.
        J Psychosom Res. 2012; 73: 86-91
        • Rubin Z.
        • Peplau L.A.
        Who believes in a just world?.
        J Soc Issues. 1975; 31: 65-89
        • Scott W.
        • Sullivan M.
        Perceived injustice moderates the relationship between pain and depressive symptoms among individuals with persistent musculoskeletal pain.
        Pain Res Manag. 2012; 17: 335-340
        • 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
        • Seligman M.E.
        • Reivich K.
        • Jaycox L.
        • Gillham J.
        • Kidman A.D.
        The Optimistic Child.
        Houghton Mifflin, New York2007
        • Smart Richman L.
        • Leary M.R.
        Reactions to discrimination, stigmatization, ostracism, and other forms of interpersonal rejection: A multimotive model.
        Psychol Rev. 2009; 116: 365
        • Steinberg L.
        • Cauffman E.
        Maturity of judgment in adolescence: Psychosocial factors in adolescent decision making.
        Law Hum Behav. 1996; 20: 249
        • Steinberg L.
        Cognitive and affective development in adolescence.
        Trends Cogn Sci. 2005; 9: 69-74
        • Stevens J.P.
        Applied Multivariate Statistics for the Social Sciences.
        Erlbaum, Hillsdale, NJ1992
        • 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.
        • Bishop S.R.
        • Pivik J.
        The Pain Catastrophizing Scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • 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.
        • 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
        • Sullivan M.J.
        • Thorn B.
        • Haythornthwaite J.A.
        • Keefe F.
        • Martin M.
        • Bradley L.A.
        • Lefebvre J.C.
        Theoretical perspectives on the relation between catastrophizing and pain.
        Clin J Pain. 2001; 17: 52-64
        • Sullivan M.J.
        • Yakobov E.
        • Scott W.
        • Tait R.
        Perceived injustice and adverse recovery outcomes.
        Psychol Inj Law. 2014; 7: 325-334
        • Tabachnick B.G.
        • Fidell L.S.
        Using Multivariate Statistics.
        Allyn and Bacon, Boston2001
        • Trost Z.
        • Van Ryckeghem D.
        • Scott W.
        • Guck A.
        • Vervoort T.
        The impact 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.
        J Pain. August 21, 2016; ([Epub ahead of print])
        • Trost Z.
        • Strachan E.
        • Sullivan M.
        • Vervoort T.
        • Avery A.R.
        • Afari N.
        Heritability of pain catastrophizing and associations with experimental pain outcomes: A twin study.
        Pain. 2015; 156: 514-520
        • Varni J.W.
        • Burwinkle T.M.
        • Seid M.
        • Skarr D.
        The PedsQL™ 4.0 as a pediatric population health measure: Feasibility, reliability, and validity.
        Ambul Pediatr. 2003; 3: 329-341
        • Vervoort T.
        • Goubert L.
        • Eccleston C.
        • Bijttebier P.
        • Crombez G.
        Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain.
        J Pediatr Psychol. 2006; 31: 674-683
        • 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
        • Walker L.S.
        • Greene J.W.
        The functional disability inventory: Measuring a neglected dimension of child health status.
        J Pediatr Psychol. 2001; 16: 39-58
        • Walker L.J.
        • Hennig K.H.
        • Krettenauer T.
        Parent and peer contexts for children’s moral reasoning development.
        Child Dev. 2000; 71: 1033-1048
        • Wilson A.C.
        • Moss A.
        • Palermo T.M.
        • Fales J.L.
        Parent pain and catastrophizing are associated with pain, somatic symptoms, and pain-related disability among early adolescents.
        J Pediatr Psychol. 2014; 39: 418-426
        • 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
        • Zeman J.
        • Cassano M.
        • Perry-Parrish C.
        • Stegall S.
        Emotion regulation in children and adolescents.
        J Dev Behav Pediatr. 2006; 27: 155-168