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J Pain. 2019 Jan;20(1):83-96. doi: 10.1016/j.jpain.2018.08.005. Epub 2018 Sep 1.

Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain.

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Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address:
Department of Anaesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington.
Department of Family Medicine, John Peter Smith Health Network, Ft. Worth, Texas.
Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California.
Department of Psychology, University of North Texas, Denton, Texas.
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, England.


Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP), no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on white/Caucasian participant samples. The current study examined the associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N = 137) -51 (37.2%) white, 43 (31.4%) Hispanic, 43 (31.4%) black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated the association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared with white and Hispanic participants, black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression and pain-related disability. Black participants also reported higher pain intensity than white participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially informed antecedents of injustice appraisals. Perspective: Perceived injustice predicted worse outcomes in CLBP, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than their white or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.


Perceived injustice; chronic low back pain; racial disparities

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