Perceived Injustice and Pain Outcomes in Youth With Chronic Pain

Abstract

The biopsychosocial model of pain (Gatchel, 2004; Gatchel et al., 2007) emphasizes complex interplay of biological, psychological, and social factors of chronic pain conditions. As pain emotions are recognized to influence perceptions of chronic pain, the model incorporates a comprehensive approach to understanding complex health conditions. Beliefs regarding the fairness of one’s pain, e.g., feelings of perceived injustice, have recently been found to affect pain experience in both youth and adults (Miller et al., 2018; Sullivan et al., 2008; Sullivan, et al., 2012). There is limited understanding, however, regarding how perceived injustice is influenced by parents or managed by their child. Understanding processes linking perceived injustice to adverse pain outcomes may provide insight to intervention strategies that may mitigate its impact.

The current study examined the association between perceived injustice, emotion regulation, and pain interference. Self-reported data was collected from 30 patients (ages 10-18) from the chronic pain clinic at Texas Children’s Hospital. Measures included the Patient- Reported Outcomes Measurement Information System’s (PROMIS), Injustice Experience Questionnaire- Parent, Child (IEQ PC, IEQ Child), and the Emotion Regulation Questionnaire (ERQ). Results indicated that variables were independent from one another and did not suggest associations found in past studies (Koechlin et al., 2018; Miller et al., 2018). Notable differences between parent and patient reporting were found as well. Parents reported higher levels of pain interference compared to the patient. Patients reported higher levels of perceived injustice compared to their parents. Over half the parent and patient dyads were established as concordant in their reporting of perceived injustice related to the child’s pain experience. Concordant groups reported higher emotion regulation for cognitive reappraisal and expressive suppression.

Attaining a comprehensive understanding of multifaceted factors related to the chronic pain experience may guide therapeutic interventions. Analyzing these features is essential for identifying groups with increased predisposition and severity of chronic pain (Turk & Okifuji, 2002). Furthermore, capturing how differing perspectives of chronic health conditions are for caregiver and child sheds light on understanding the social aspect of the multilayered, pain experience.