[Validation of the German-language version of the Injustice Experience Questionnaire (IEQ) in five outpatient clinics]

Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire

OBJECTIVES

Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ.

METHODS

We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity.

RESULTS

We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity.

DISCUSSION

Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.

Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors

BACKGROUND

Chronic pain is a complex biopsychosocial phenomenon. Lifestyle, behavioral, socioeconomic, and psychosocial factors such as depression and perceived injustice are often associated with the development of chronic pain and vice versa. We sought to examine the interaction of these factors with opioid intake.

METHODS

At our institution, 164 patients with chronic pain undergoing an interdisciplinary assessment within a three-month period participated in the study and completed the Injustice Experience Questionnaire (IEQ). Data regarding opioid intake, pain levels, pain diagnosis, depression, anxiety, stress, quality of life, pain-related disability, habitual well-being, occupational status, and ongoing workers compensation litigation were extracted from the patients' charts.

RESULTS

Approximately one-fourth of the patients used opioids. The IEQ total was significantly higher in patients using Schedule III opioids. Depression, but not the anxiety and stress scores, were significantly higher in patients using opioids. There were no significant differences regarding pain-related disability, habitual well-being, and the coded psychosocial diagnoses. In the patient group without opioids, the percentage of employed persons was significantly higher but there were no significant differences regarding work leave, pension application, or professional education.

CONCLUSIONS

Opioid use appears to be more closely related to psychological factors and single social determinants of pain than to somatic factors.

Translation and validation of the Norwegian version of the Injustice Experience Questionnaire

OBJECTIVES

Perceived injustice is a theoretical construct comprising elements of loss, attribution of blame, and sense of unfairness. Patients with chronic pain often report high levels of perceived injustice, which can have negative impact on physiological and psychosocial aspects and treatment outcome. The Injustice Experience Questionnaire (IEQ) is a self-report 12-item questionnaire that shows good reliability and validity in patients with chronic pain. This study aimed to translate, validate, and expand the use of the Norwegian Injustice Experience Questionnaire (IEQ-N) to a chronic pain population.

METHODS

A mixed-method approach was used to translate and validate the IEQ-N. It was forward-back translated, linguistically validated, and culturally adapted. Individual cognitive debriefing interviews (n=7) and a focus group interview (n=9) was used to explore the patients' experience with- and understanding of the questionnaire. Statistical descriptive, correlational, factor- and regression analyses were used to investigate the IEQ-N validity, reliability, and factorial structure in a large registry sample (n=3,068) of patients with chronic pain.

RESULTS

Patients with chronic pain found the IEQ-N relevant. Registry analyses supported that the IEQ-N had a one-factor structure. The internal consistency was high (Chronbach's alpha=0.92). The construct validity was good, with moderate to strong significant univariate correlation (r=0.29-0.71) (p<0.05) between perceived injustice and related constructs of pain catastrophizing, pain severity, disability, psychological distress, and quality of life. Perceived injustice contributed with significant but small unique variance to pain-related factors (i.e., pain intensity, pain-related disability, psychological distress), but the additional contribution beyond pain catastrophizing was small (0.2-6.7%) (p<0.05).

CONCLUSIONS

Patients in the study found the questionnaire relevant for their situation, and easy to understand. This study provides a reliable and valid Norwegian tool to assess perceived injustice in patients with chronic pain.

ETHICAL COMMITTEE NUMBER

REK sør-øst, 2016/1942.

The Pain-to-Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain

Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being. Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia. Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34-0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41. Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.