The role of perceived injustice in the prediction of pain and function after total knee arthroplasty

Pain. 2014 Oct;155(10):2040-6. doi: 10.1016/j.pain.2014.07.007. Epub 2014 Jul 24.


Emerging evidence suggests that the appraisal of pain and disability in terms of justice-related themes contributes to adverse pain outcomes. To date, however, research on the relation between perceived injustice and pain outcomes has focused primarily on individuals with musculoskeletal injuries. The primary aim of this study was to investigate the role of perceived injustice in the prediction of pain and disability after total knee arthroplasty (TKA). The study sample consisted of 116 individuals (71 women, 45 men) with osteoarthritis of the knee scheduled for TKA. Participants completed measures of pain severity, physical disability, perceptions of injustice, pain catastrophizing, and fear of movement before surgery, and measures of pain and disability 1 year after surgery. Prospective multivariate analyses revealed that perceived injustice contributed modest but significant unique variance to the prediction of postsurgical pain severity, beyond the variance accounted for by demographic variables, comorbid health conditions, presurgical pain severity, pain catastrophizing, and fear of movement. Pain catastrophizing contributed significant unique variance to the prediction of postsurgical disability. The current findings add to a growing body of evidence supporting the prognostic value of perceived injustice in the prediction of adverse pain outcomes. The results suggest that psychosocial interventions designed to target perceptions of injustice and pain catastrophizing before surgery might contribute to more positive recovery trajectories after TKA.

Keywords: Arthritis; Disability; Pain; Pain catastrophizing; Perceived injustice; TKA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Arthroplasty, Replacement, Knee / psychology
  • Catastrophization / psychology*
  • Disability Evaluation
  • Fear / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / surgery*
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / psychology*
  • Perception*
  • Prognosis
  • Prospective Studies
  • Recovery of Function / physiology*