Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction

Depression and pain interference are significant mediators of the relationship between pain catastrophizing, perceived injustice, and pain intensity on life satisfaction.

Key Points

Highlights

• Pain intensity and cognitive factors contribute to reduced life satisfaction. These effects were fully mediated by pain interference and depressive symptoms.
• Perceived injustice predicted life satisfaction, above and beyond other variables.

Importance

• The role of the cognitive appraisal processes of perceived injustice and catastrophizing are rarely examined in predictive models of pain and have not been related specifically to life satisfaction.
• This study investigates the direct effects of pain intensity, perceived injustice, and pain catastrophizing on life satisfaction and examines pain interference and depression as potential mediators. 

What’s Done Here

• This study is a secondary data analysis of a questionnaire validation study: Data from 330 participants included in the analysis.
• Depression and pain interference were assessed using the Patient-Reported Outcome Measurement Information System, Depression and Pain Interference instruments.
• Average pain intensity was rated on an "11-point numerical rating scale", life satisfaction was assessed using the "5-item Satisfaction with Life Questionnaire", pain catastrophizing was assessed using the "Pain Catastrophizing Scale" and perceived injustice was assessed using the "Injustice Experience Questionnaire". Path models were used to analyze the data.

Key Results

• Higher scores for pain catastrophizing, perceived injustice and pain intensity correlated with lower life satisfaction.
• Depressive symptoms mediated the relationship between pain catastrophizing and life satisfaction.
• Pain interference mediated the relationship between pain intensity and life satisfaction.
• Although both "depressive symptoms" and "pain interference" were found to mediate the relationship between "perceived injustice and life satisfaction", "perceived injustice" continued to independently demonstrate a relationship with "life satisfaction".

Limitations of the Study

• The study is cross-sectional and does not allow an understanding of the results and relations over the time.
• Data on anger or social isolation were not collected, which are two important factors shown to have a relationship with perceived injustice.
• The majority of study participants were Caucasian.

Lay Summary

Cognitive appraisals have been shown to have an effect on the experience of pain. Notably, perceived injustice and pain catastrophizing have been shown to play a role, but are rarely examined together. In addition, variability in appraisal processes has been shown to be related to adjustment and recovery outcomes, such as depression and pain-related interference, which may impact the quality of life.

Therefore, the authors of this study from the University of Washington, Stanford Systems Neuroscience and Pain Laboratory and the University of Alabama; investigated the direct effects of pain intensity, perceived injustice, and pain catastrophizing on life satisfaction while examining depression and pain-related interference as potential mediators. The authors expected that a significant degree of the effects of pain intensity, pain catastrophizing and perceived injustice on life satisfaction would be explained by the presence of depressive symptoms and pain-related interference.

The article published in the Scandinavian Journal of Pain entitled "Pain catastrophizing, perceived injustice and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption" found that higher scores for pain catastrophizing, perceived injustice and pain intensity correlated with lower life satisfaction. Although pain-related interference in daily life and depressive symptoms are related to pain intensity, catastrophizing, and perceived injustice, they appeared to have a more central role in determining life satisfaction. Interestingly, when both depressive symptoms and pain interference were present in the model, no remaining relationship was found between either pain catastrophizing or pain intensity with life satisfaction. However, perceived injustice continued to show an effect on life satisfaction. 

The authors conclude that depressive symptoms mediate the relationship between pain catastrophizing and life satisfaction, while pain interference mediates the relationship between pain intensity and life satisfaction. Both depressive symptoms and pain interference seem to mediate the relationship between perceived injustice and life satisfaction, but perceived injustice continued to independently demonstrate a relationship with life satisfaction. This suggests that other potential mediators that were not assessed in the current study may connect perceived injustice and life satisfaction.

The authors note that future research must be conducted based on the findings of this study. For example, social isolation and anger should be included in the analysis of perceived injustice, as they have been shown to have significant relationships with perceived injustice in other studies. Furthermore, as the cross-sectional nature of the data was a limitation within the current study, future research should analyze the variables within this study over time.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29074199