Background & Aims
Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed to examine the roles of PI and anger in mediating pain across Fibromyalgia patients with and without comorbid anxiety/depression (FM+A/D, FM-A/D respectively), as well as Rheumatoid Arthritis (RA) patients, and healthy controls (HC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and HC respectively. We further aimed to validate a Hebrew version of the IEQ, hypothesizing positive correlations between PI, anger, and pain, with anger mediating the relationship between PI and pain.
Methods
We translated the IEQ using the forward-backward method, and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 HC. Assessments across groups included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. Structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach’s alpha. Correlations between all measures were assessed, and bootstrapped-based modelling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity.
Results
We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the most severe scores for PI and anger, as well as in all other clinical and psychological measures. These results remained significant after controlling for demographic factors, depression and anxiety, and duration of diagnosis.
Within the FM+A/D group only, we found trait anger to moderate the mediating effect of state anger in the relationship between PI and pain intensity.
Conclusions
Our findings validate a Hebrew IEQ, and offer a novel understanding of the interaction between state and trait anger in the context of PI in chronic pain. Crucially, this interaction varies according to the specific diagnosis and manifestation of chronic pain, particularly in individuals suffering from comorbid mental health conditions. We discuss the mechanical and clinical implications.
References
Adachi T, Yamada K, Fujino H, et al. Associations between anger and chronic primary pain: a systematic review and meta-analysis. Scand J Pain 2022; 22: 1–13.
Carriere JS, Donayre Pimentel S, Yakobov E, et al. A Systematic Review of the Association Between Perceived Injustice and Pain-Related Outcomes in Individuals with Musculoskeletal Pain. Pain Med 2020; 21: 1449–1463.
Ferrari R, Russell AS. Perceived injustice in fibromyalgia and rheumatoid arthritis. Clin Rheumatol 2014; 33: 1501–1507.
Galvez-Sánchez CM, Reyes del Paso GA, Duschek S, et al. The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps. J Clin Med 2022; 11: 844.
Gilam G, Hendler T. Deconstructing Anger in the Human Brain. In: Current topics in behavioral neurosciences. 2015, pp. 257–273.
Gilam G, Gross JJ, Wager TD, et al. What Is the Relationship between Pain and Emotion? Bridging Constructs and Communities. Neuron 2020; 107: 17–21.
Lynch J, Fox S, D’Alton P, et al. A Systematic Review and Meta-Analysis of the Association Between Perceived Injustice and Depression. J Pain 2021; 22: 643–654.
Miller MM, Williams AE, Scott EL, et al. Battle of the Appraisals: Pain-Related Injustice Versus Catastrophizing as Mediators in the Relationship Between Pain Intensity and 3-Month Outcomes in Adolescents with Chronic Pain. J Pain 2022; 23: 223–235.
Okifuji A, Turk DC, Curran SL. Anger in chronic pain: Investigations of anger targets and intensity. J Psychosom Res 1999; 47: 1–12.
Scott W, Trost Z, Bernier E, et al. Anger differentially mediates the relationship between perceived injustice and chronic pain outcomes. PAIN® 2013; 154: 1691–1698.
Scott W, Sullivan M. Perceived injustice moderates the relationship between pain and depressive symptoms among individuals with persistent musculoskeletal pain. Pain Res Manag J Can Pain Soc 2012; 17: 335–340.
Sullivan MJL, Adams H, Horan S, et al. The Role of Perceived Injustice in the Experience of Chronic Pain and Disability: Scale Development and Validation. J Occup Rehabil 2008; 18: 249–261.
Trost Z, Vangronsveld K, Linton SJ, et al. Cognitive dimensions of anger in chronic pain. Pain 2012; 153: 515–517.
Trost Z, Scott W, Buelow MT, et al. The association between injustice perception and psychological outcomes in an inpatient spinal cord injury sample: the mediating effects of anger. Spinal Cord 2017; 55: 898–905.
Presenting Author
Jemma Silvert
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial