Perceived Injustice, Chronic Low Back Pain Intensity, and Ethnicity

Back pain
Back pain
Perceptions of injustice may predict worse outcomes in patients with chronic low back pain.

Perceptions of injustice may predict worse outcomes in patients with chronic low back pain (CLBP), according to a study published in the Journal of Pain. Perceived injustice has emerged as a risk factor for problematic pain outcomes in disorders of the musculoskeletal system. In addition, despite a high prevalence of CLBP, most studies examining the role of perceived injustice in CLBP are limited to white populations. 

The authors sought to examine the associations between perceived injustice and CLBP in a diverse population.  A total of 137 participants (53% men; 37.2% white; 31.4% black; 31.4% Hispanic) were recruited from community sources from the southwest United States.  Patients were asked to fill out questionnaires: the Pain Rating Index of the McGill Pain Questionnaire — Short Form to assess pain intensity, (. the Roland and Morris disability questionnaire to evaluate functional status, the Patient Health Questionnaire-9 to assess depressive symptoms, and the Injustice Experiences Questionnaire to evaluate perceived injustice, which assesses several measures of depression and disability. 

Black participants reported higher levels of perceived injustice related to CLBP (P <.001), higher depression (P =.019), and greater pain-related disability (P =.001), compared with white and Hispanic participants. Black participants also reported higher pain intensity than white participants (P =.04). 

Limitations include the cross-sectional nature of the study, and the inability to establish the causal vs temporal associations between the examined variables.

”[These] findings support the contribution of injustice appraisals to functional and psychosocial outcomes among individuals with CLBP, above and beyond sociodemographic and psychosocial contributors [and] add to the growing literature on racial disparities in injustice appraisals in musculoskeletal pain and injury,” concluded the study authors.

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Trost Z, Sturgeon J, Guck A, et al. Examining injustice appraisals in a racially diverse sample of individuals with chronic low back pain [published online September 1, 2018]. J Pain. doi: 10.1016/j.jpain.2018.08.005.