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

John A. Sturgeon 1 , Maisa S. Ziadni 2 , Zina Trost 3 , Beth D. Darnall 2 ,  and Sean C. Mackey 2
  • 1 University of Washington School of Medicine, Department of Anesthesiology and Pain Medicine, WA 98102, Seattle, USA
  • 2 Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesia, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
  • 3 Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd., Room 415, Birmingham, AL, USA
John A. Sturgeon
  • Corresponding author
  • University of Washington School of Medicine, Department of Anesthesiology and Pain Medicine, Seattle, WA 98102, USA
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, Maisa S. Ziadni
  • Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesia, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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, Zina Trost
  • Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd., Room 415, Birmingham, AL, 35294, USA
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, Beth D. Darnall
  • Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesia, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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and Sean C. Mackey
  • Stanford Systems Neuroscience and Pain Laboratory, Department of Anesthesia, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Abstract

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.

Methods

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

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.

Conclusions

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.

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