Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States.
Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.
Pain. 2024 Jul 1;165(7):1583-1591. doi: 10.1097/j.pain.0000000000003160. Epub 2024 Jan 19.
Individuals' appraisals regarding the injustice of their pain or physical injury have emerged as a significant risk factor for worse physical and psychological outcomes. Injustice appraisals are defined by perceptions of external blame for pain or injury and viewing pain or injury as a source of irreparable loss. To date, research on the impact of injustice appraisal has been primarily cross sectional, and existing longitudinal studies have examined injustice appraisals at only 2 time points in the context of rehabilitation treatment. This study examined the trajectory of injustice appraisals in 171 patients admitted for traumatic injury at admission, as well as 3, 6, and 12 months after discharge and examined injustice appraisals as a potential moderator of recovery after injury. Findings can be summarized as follows: First, injustice perception was largely stable in the 12 months after hospital discharge. Second, elevated injustice perception was associated with decreased recovery in pain intensity and depressive symptomatology over the study period but did not moderate changes in pain catastrophizing or posttraumatic stress symptomatology over time. This study is the first naturalistic prospective analysis of injustice appraisal following trauma admission within the American healthcare system. Findings indicate that injustice appraisals do not naturally decrease in the aftermath of traumatic injury and may be a risk factor for poorer physical and psychological recovery. Future research should examine additional sociodemographic and psychosocial factors that may contribute to elevated injustice appraisal, as well as ways of addressing the potential deleterious impact of injustice appraisals in treatment settings.
个体对自身疼痛或身体损伤的不公正感评估已成为影响身体和心理预后更差的一个重要风险因素。不公正感评估是通过对外界对疼痛或损伤的指责的看法以及将疼痛或损伤视为不可挽回的损失的来源来定义的。迄今为止，关于不公正感评估影响的研究主要是横断面研究，现有的纵向研究仅在康复治疗的背景下，在 2 个时间点上考察了不公正感评估。本研究在创伤性损伤住院时、出院后 3、6 和 12 个月时评估了 171 名患者的不公正感评估轨迹，并考察了不公正感评估作为损伤后恢复的潜在调节因素。研究结果可以概括如下：首先，在出院后 12 个月内，不公正感知在很大程度上保持稳定。其次，不公正感知与疼痛强度和抑郁症状在研究期间的恢复减少有关，但并未调节疼痛灾难化或创伤后应激症状随时间的变化。本研究是在美国医疗保健系统中对创伤性损伤后不公正感评估进行的首次自然前瞻性分析。研究结果表明，不公正感知在创伤性损伤后不会自然减少，并且可能是身体和心理恢复较差的风险因素。未来的研究应进一步考察可能导致不公正感升高的其他社会人口学和心理社会因素，以及在治疗环境中解决不公正感潜在有害影响的方法。
