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Licensed Unlicensed Requires Authentication Published by De Gruyter October 1, 2017

Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption

  • John A. Sturgeon EMAIL logo , Maisa S. Ziadni , Zina Trost , Beth D. Darnall and Sean C. Mackey


Background and purpose

Previous research has highlighted the importance of cognitive appraisal processes in determining the nature and effectiveness of coping with chronic pain. Two of the key variables implicated in appraisal of pain are catastrophizing and perceived injustice, which exacerbate the severity of pain-related distress and increase the risk of long-term disability through maladaptive behavioural responses. However, to date, the influences of these phenomena have not been examined concurrently, nor have they been related specifically to quality of life measures, such as life satisfaction.


Using data froman online survey of330 individuals with chronic pain, structural path modelling techniques were used to examine the independent effects of pain catastrophizing, perceived injustice, and average pain intensity on life satisfaction. Two potential mediators of these relationships were examined: depressive symptoms and pain-related interference.


Results indicated that depressive symptoms fully mediated the relationship between pain catastrophizing and life satisfaction, and pain interference fully mediated the relationship between pain intensity and life satisfaction. Both depressive symptoms and pain interference were found to significantly mediate the relationship between perceived injustice and life satisfaction, but perceived injustice continued to demonstrate a significant and negative relationship with life satisfaction, above and beyond the other study variables.


The current findings highlight the distinct affective and behavioural mediators of pain and maladaptive cognitive appraisal processes in chronic pain, and highlight their importance in both perceptions of pain-related interference and longer-term quality of life.

  1. Ethical issues: The current study was conducted under an IRB-approved protocol for an observational study (a questionnaire validation study; study results not presented here). Participant consent was obtained using the online REDCap system by clicking a link after being provided an information sheet on the online study; participants could not advance to completing study questionnaires without completing the online informed consent. The study protocol was not registered with any organization outside of the institution where the study was conducted.

  2. Conflicts of interest: The authors have no conflicts of interest to disclose.


This work was supported by the National Institutes of Health (NIH) NIDA T32DA035165 (JAS, MSZ) and K24DA029262 (SCM), NCCIH R01AT008561 and P01AT006651 (BDD, SCM). The authors would like to offer their sincere thanks to The National Pain Report for their assistance with this project.


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Received: 2017-08-17
Revised: 2017-09-25
Accepted: 2017-09-26
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

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