This is not the first time feelings of personal injustice have been
tied to longer recovery times and increased disability after injury,
the authors write.
“Pain is a complex phenomenon that is influenced by biological,
social, and psychological factors,” said lead author Esther Yakobov,
a doctoral student in clinical psychology at McGill University in
“Studies conducted with patients who suffer from chronic pain
because of an injury demonstrated that individuals who judge their
experience as unfair, focus on their losses, and blame others for
their painful condition also tend to experience more pain and
recover from their injuries slower than individuals who do not,” she
told Reuters Health by email.
But those studies had been with victims of injuries, where
externalizing blame is a bit easier than for degenerative conditions
like osteoarthritis, she noted.
For the new study, a group of 116 men and women with severe
osteoarthritis, between ages 50 and 85 years old and scheduled for
knee replacement surgery in Canada, first filled out questionnaires
assessing perceived injustice, how much they think about or worry
about pain and their fear of movement or re-injury.
They rated their agreement with statements like, “It all seems so
unfair” and “I am suffering because of someone else’s negligence.”
With another clinical questionnaire the patients gauged their pain
levels and physical functioning.
After the knee replacement surgeries, which were all deemed
successful, the patients rated their pain and function again at a
The more a patient agreed before surgery that life seems unfair and
others are to blame for their problems, the more pain they reported
experiencing one year after surgery. That was true even when age,
sex, other health conditions and pre-surgery pain levels were
accounted for, according to the results in the journal Pain.
The more the patient thought about pain and felt helpless because of
it before surgery, the more severe their disability during recovery
seemed to be.
“A decade ago, we reported that preoperative anxiety and depression
influenced the outcome after surgery,” said Dr. Victoria Brander, a
physical medicine and rehabilitation specialist at Northwestern
Orthopaedic Institute in Chicago.
This new study adds to the effort to refine the concept, identifying
specific psychological characteristics that serve as risk factors
for complicated or painful recovery, Brander, who was not part of
the new study, told Reuters Health by email.
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“All of these psychological factors point to the fact that patients
who perceive themselves as helpless, those who are afraid, those who
feel loss of control, have a more difficult time,” Brander said.
“The contrary is also true - patients who exhibit high levels of
‘self-efficacy’ (that is, patients who have a high degree of
confidence in their own ability to achieve a goal) appear to do best
after knee replacement,” she said.
Osteoarthritis, the wearing away of cartilage, joint lining,
ligaments and bone in a joint, affects one third of people over age
65 in the U.S., according to the Centers for Disease Control and
Knee replacement surgery can relieve pain and restore mobility, but
about 20 percent of patients will have a problematic recovery or
intense pain, based on previous research.
How individuals perceive pain as just or unjust can vary widely
between patients, and it can be influenced by many factors, so it’s
hard to say if having a more negative outlook is common or uncommon,
Researchers don’t yet know if people with more negative outlooks
only perceive their pain as worse than others or if their
psychological state affects the physiology of healing and actually
leads to more pain, she said.
Nevertheless, findings like this suggest patients should be screened
for their psychosocial outlook before surgery, she said.
“This might suggest the usefulness of screening patients in terms of
‘catastrophizing,’ perceived injustice, fear of movement, and
recovery expectancies before treatment or surgery,” she said. “With
this screening information, appropriate psychological intervention
that targets specific risk factors of each patient can then be
matched to patients’ needs.”
SOURCE: http://bit.ly/1qOr9BB Pain, online July 25, 2014.
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