Child appraisals of injustice in the context of acute and chronic pain: An interpretative phenomenological analysis.

BACKGROUND: Recent research has found child pain-related injustice appraisals to be associated with adverse pain-related outcomes. However, this evidence is mainly based on research using a measure developed for adults in the context of accident-related injuries, which may not translate to paediatric pain populations. Research on the phenomenology of child pain-related injustice appraisals is lacking. This study aimed to examine the phenomenology of pain-related injustice appraisals among both pain-free children and children living with chronic pain, to compare and contrast their experiences. METHODS: Two focus groups were held with pain-free children (n = 16), and three focus groups were held with paediatric chronic pain patients attending a rehabilitation centre (n = 15) in Belgium. Interpretative phenomenological analysis was applied. RESULTS: Two injustice-related themes were generated from the focus groups with pain-free children: (1) 'Someone else is at fault' and (2) 'I am in pain and he is not'. Two injustice-related themes were generated from the focus groups with paediatric chronic pain patients: (1) 'People don't see my pain' and (2) 'I am missing out because of my pain'. CONCLUSIONS: This study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric pain patients. Findings highlight the interpersonal nature of lived injustice experiences caused by chronic pain, which is not fully captured by existing child pain-related injustice measures. Findings further suggest that pain-related injustice notions may not be extrapolated from a chronic to an acute pain context. SIGNIFICANCE: The current study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric chronic pain patients. Findings highlight the interpersonal nature of injustice appraisals that are specific to the experience of chronic rather than acute pain. These appraisals are not fully captured by current child pain-related injustice measures.

Initial validation of a virtual blood draw exposure paradigm for fear of blood and needles.

Fear of blood, injections, and needles commonly prevents or delays individuals' receipt of health care, such as vaccines or blood draws. Innovative methods are needed to overcome these fears and reduce anxiety related to activities of this nature. The present study describes initial testing of an arm illusion paradigm that may prove useful during early phases of graded exposure for people with blood and needle fear. Seventy-four undergraduate students aged 18-29 years were tested. In line with study aims, results indicated that the virtual blood draw paradigm promoted strong perceptions of arm ownership and elicited significant changes in physiological indices (blood pressure, heart rate, electrodermal activity, respiratory rate) in response to key procedure elements (e.g., needle insertion). Further, bivariate correlations indicated that individual differences in self-reported blood and needle fear collected prior to the illusion paradigm were significantly associated with presyncopal symptoms reported following the procedure. In regression analyses, self-reported measures of blood and needle fear explained unique variance in presyncopal symptoms even after controlling for general state anxiety. These findings provide initial support for the virtual blood draw paradigm as a promising tool to help provide graded exposure to medical procedures involving needles and blood draw.

Event centrality as a unique predictor of posttraumatic stress symptoms and perceived disability following spinal cord injury.

STUDY DESIGN: We conducted a cross-sectional study involving completion of self-report measures. OBJECTIVES: Individuals who acquire a spinal cord injury (SCI) face numerous physical and psychological challenges, with the former receiving considerable less attention during the rehabilitation process. In this article, we examined event centrality as a unique predictor of psychological outcomes in a sample of individuals receiving rehabilitation for SCI. Event centrality refers to the extent to which individuals construe a stressful experience as a core part of their identity. In samples of individuals exposed to psychological traumas (for example, sexual assault or military combat), event centrality has emerged as a consistent and powerful predictor of posttraumatic stress symptoms (PTSSs). This is the first study to examine event centrality in an SCI sample. SETTING: Inpatient rehabilitation program in a large urban city in the Southwestern United States. METHODS: A sample of 55 participants in rehabilitation for a recent SCI completed measures of event centrality, PTSS, depressed mood and perceived disability. RESULTS: Event centrality was significantly related to perceived disability (r=0.48) and PTSS (r=0.31) and accounted for unique variance in these two outcomes after controlling for demographics and depressed mood. CONCLUSION: Event centrality is common among individuals with SCI and may be a unique contributor to worse psychological and functional outcomes. We hope our findings will alert health-care professionals to the importance of event centrality. SPONSORSHIP: This study was supported by a grant from the Danish National Research Foundation (DNRF89).

The association between injustice perception and psychological outcomes in an inpatient spinal cord injury sample: the mediating effects of anger.

STUDY DESIGN: Cross-sectional study design involving completion of self-report measures. OBJECTIVE: To investigate the relationship between perceived injustice, post-traumatic stress symptoms and depression in a sample of individuals receiving inpatient rehabilitation care following hospitalization for acute spinal cord injury (SCI), as well as the mediating role of anger variables. SETTING: Inpatient rehabilitation program in a large urban city in the Southwestern United States. METHODS: A sample of 53 participants with an average of 204.51 days (s.d.=410.67, median=56) post injury occurrence completed measures of perceived injustice, depression and post-traumatic stress symptoms as well as measures of trait anger, state anger, anger inhibition and anger expression. RESULTS: Perceived injustice was significantly correlated with depression and post-traumatic stress symptoms, and accounted for unique variance in depression and post-traumatic stress symptoms when controlling for demographic and injury-related variables. Anger inhibition was found to mediate the relationship between perceived injustice and depression. Trait anger and anger expression were found to mediate the relationship between perceived injustice and post-traumatic stress symptoms. CONCLUSIONS: Consistent with previous research, perceived injustice was associated with greater depression and post-traumatic stress symptoms. The results support previous findings that anger inhibition mediates between perceived injustice and depression, and provides novel findings regarding mediation of post-traumatic stress symptoms. Results provide preliminary evidence for the role of perceived injustice in SCI and potential mechanisms by which it may exert its effects.

Resilience following spinal cord injury: a phenomenological view.

STUDY DESIGN: Qualitative research design involving semi-structured focus groups. OBJECTIVES: To increase current understanding of how persons with spinal cord injuries (SCI) define resilience and what factors contribute to their resilience or the resilience of others. SETTING: Inpatient rehabilitation program in a large urban city in the Southwestern United States. METHODS: A convenience sample of 28 participants (14 current patients; 14 former patients) participated in semi-structured focus groups led by the research investigators. RESULTS: Through a constant comparative analysis of the data, six themes emerged in participants' responses regarding what they believed contributed to their own resilience in adapting to SCI. The six themes included psychological strength, social support, perspective, adaptive coping, spirituality or faith, and serving as a role model or inspiring others. CONCLUSION: Consistent with previous research findings, individuals with SCI identified positive thinking (for example, optimism, hope and positive attitude), perseverance and determination, and social support from friends and family as important contributors to their ability to adapt in spite of experiencing traumatic events that resulted in SCI. Findings provide richness and depth to current empirical conceptualizations of resilience.

An experimental investigation of the effect of a justice violation on pain experience and expression among individuals with high and low just world beliefs.

BACKGROUND: Perceptions of injustice are linked with poorer physical and psychological outcomes in the context of pain and injury. Violations of injustice can arise out of violations of just world belief (JWB). However, no study has yet examined whether JWB moderates the effect of justice violation on pain experience. METHODS: The current study examined the effect of an experimental justice violation on acute pain outcomes and whether JWB moderated this effect. Participants completed the JWB scale and then engaged in two cold pressor tasks (CPT). Half the participants were told that the second CPT immersion was part of standard protocol; the other half were told that the painful procedure had to be repeated due to experimenter negligence. Participants provided report of pain intensity following each CPT immersion. Video records of participants undergoing the CPT were coded for presence and duration of pain behaviour. RESULTS: Exposure to the justice violation resulted in elevated pain intensity from the first to the second immersion only among participants with high JWB. For participants with low JWB and participants in the control condition, there was no significant difference in pain intensity across immersions. Control participants showed a decrease in pain behaviour from the first to the second immersion. In the negligence/ justice violation condition, reductions in pain behaviour were observed only among participants with low JWB. CONCLUSIONS: Our results indicate that individuals with high JWB may show particularly adverse reactions in response to justice violations in the context of acute pain experience.