Yakobov Esther, Scott Whitney, Stanish William D, Tanzer Michael, Dunbar Michael, Richardson Glen, Sullivan Michael J L
Departments of Psychology.
Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Clin J Pain. 2018 May;34(5):415-420. doi: 10.1097/AJP.0000000000000551.
Perceptions of injustice have been associated with problematic recovery outcomes in individuals with a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice (PI), it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice. The present study examined the relative contributions of postsurgical reductions in pain severity, depressive symptoms, and disability to the prediction of reductions in perceptions of injustice.
The study sample consisted of 110 individuals (69 women and 41 men) with osteoarthritis of the knee scheduled for total knee arthroplasty (TKA). Patients completed measures of perceived injustice, depressive symptoms, pain, and disability at their presurgical evaluation, and at 1-year follow-up.
The results revealed that reductions in depressive symptoms and disability, but not pain severity, were correlated with reductions in perceived injustice. Regression analyses revealed that reductions in disability and reductions in depressive symptoms contributed modest but significant unique variance to the prediction of postsurgical reductions in perceived injustice.
The present findings are consistent with current conceptualizations of injustice appraisals that propose a central role for symptom severity and disability as determinants of perceptions of injustice in patients with persistent pain. The results suggest that the inclusion of psychosocial interventions that target depressive symptoms and perceived injustice might augment the impact of rehabilitation programs made available for individuals recovering from TKA.
在患有各种使人衰弱的疼痛病症的个体中，对不公正的认知与不良的康复结果相关。有人提出，在慢性疼痛患者中，对不公正的认知可能是对以与疾病相关的疼痛严重程度、抑郁症状和残疾为特征的经历的反应。如果症状严重程度和残疾是导致感知不公正（PI）的重要因素，那么能够减轻症状严重程度和残疾的干预措施也应该有助于减少对不公正的认知。本研究考察了术后疼痛严重程度、抑郁症状和残疾程度的减轻对预测感知不公正减轻的相对贡献。
研究样本包括110名计划接受全膝关节置换术（TKA）的膝骨关节炎患者（69名女性和41名男性）。患者在术前评估和1年随访时完成了感知不公正、抑郁症状、疼痛和残疾程度的测量。
结果显示，抑郁症状和残疾程度的减轻与感知不公正的减轻相关，但疼痛严重程度的减轻与之无关。回归分析表明，残疾程度的减轻和抑郁症状的减轻对预测术后感知不公正的减轻有适度但显著的独特贡献。
目前的研究结果与当前关于不公正评估的概念一致，即症状严重程度和残疾程度在持续疼痛患者对不公正的认知中起核心决定作用。结果表明，纳入针对抑郁症状和感知不公正的心理社会干预措施可能会增强为从TKA手术中康复的个体提供的康复计划的效果。
