Why Me? Perceptions of Justice Influence Pain Experiences

Life has its many twists and turns – to make sense of all of it, people sometimes take a “just world” approach, reasoning that people get more or less what they deserve.

But there are some experiences – like chronic, intractable pain – that are difficult to reconcile with a sense of justice.

“We learn that justice is important, but there is no universal consensus on what is just or unjust or guidance on how to respond to injustice,” write researchers Joanna McParland and Christopher Eccelston in a new article published in Current Directions in Psychological Science.

“Prolonged suffering, such as experiencing a chronic health condition characterized by pain, can prompt perceived injustice that fluctuates throughout the trajectory of chronic pain, from the circumstances of onset, through the failed response to treatment, to an altered life of suffering.”

People may perceive injustice in relation to the losses they’ve suffered, such as loss of mobility or ability to work; they may perceive injustice at the hands of medical professionals who fail to provide adequate care; or they may see injustice at the societal level, for stigmatizing their condition.

Social justice cognitions are clearly relevant to how people experience chronic pain, but McParland and Eccleston note that little academic research has directly investigated links between the two.

In their article, the researchers review findings from several studies indicating that perceived injustice is associated with worse outcomes for those suffering from chronic pain. Those who perceive greater injustice, for example, tend to report more severe pain, are more likely to show symptoms of depression and posttraumatic stress, and report less acceptance of pain. One study suggests that pain sufferers who perceive greater injustice are also less likely to return to work one year later.

General belief in a just world, on the other hand, may be associated with improved outcomes for those experiencing chronic pain.

“Although causality cannot be established from these data, we propose that beliefs about blame and loss in judging injustice may promote suffering or block adjustment to pain,” McParland and Eccleston write, “whereas justice beliefs, in the form of the belief in a just world, may act as a personal resource that supports coping attempts in some circumstances of pain.”

The researchers identify affective, cognitive, and behavioral strategies that can either help people deal with pain or compound their suffering.

Cognitive reappraisal techniques, such as those that ask sufferers to imagine how their situation could be worse or to find meaning in their experiences, may provide support to those coping with experiences of injustice. And research suggests that interventions focusing on compassion and forgiveness may offer a promising component to treatment for chronic pain.

“Many people with chronic pain interpret their experience in the context of injustice, which can impede successful adjustment to pain,” the researchers write. “Psychological interventions for chronic pain are often effective but need to evolve to take account of the effects on the pain experience of core justice beliefs and the violation of these beliefs.”

McParland, J., & Eccleston, C. (2013). “It’s not fair”: Social justice appraisals in the context of chronic pain. Current Directions in Psychological Science, 22 (6), 484-489. DOI: 10.1177/0963721413496811