Friday, 31 May 2013

It's not fair: The impact of perceived injustice on healing

We all get injured.  Muscle strains.  Headaches. Broken bones. Tendinitis. Whiplash.  Experiencing and getting through these aches and pains is part of life.  For the most part, we all want to get through them as quickly as possible.

Yet, doesn't it seem that certain people recover faster from injury than others?  Even if two people have exactly the same injury, and do exactly the same things to manage it, the healing time can still be drastically different.

So what separates us?  There is no doubting that physical characteristics, such as age and level of fitness, can impact recovery time.  However, if all things physical are held equal, healing times for the same injury can STILL differ drastically.  

Why is this? One possible explanation: the influence of the mind.

Researchers now clearly understand that injuries and recovery time are highly dependent on what is going on with a person's psychology.  We now know that pain is 100% of the time experienced in the brain.  This pain is processed in the emotional center of our mind, and depending on the state of the center, the pain we perceive can drastically change (a topic I blogged about here).

Studies (such as what is discussed here) even show that chronic back pain is more easily predicted by psycho-social factors (like depression), rather than stuff we can see with MRIs.

Or even take the classic example of chronic tendon pain (which I blogged about here).  In short, the nervous system is more of a player than the damaged tendon itself in terms of the symptoms we feel.

So it's clear that it's not just the extent of the tissue damage that dictates recovery time.  The mind and nervous system are important.  And while there are many psychological traits that impact recovery, one that has a huge influence starts with simple thought: "this isn't fair."

Perceived Injustice

Researchers now understand that perceived injustice plays a very crucial role in recovery time with any injury.  Injustice, in essence, is the sense that someone has wronged you and retribution is warranted.  In other words: you think your injury is somebody else's fault, and you want to get even.  

So does wanting to "get even" impact recovery?  This study not only explores the issue, but also looks at how a simple survey can predict the magnitude of influence that perceived injustice has.

In one part of the study, a group of patients injured either at work or a motor-vehicle accident were examined.  The patients were asked to complete the Injustice Experience Questionnaire (IEQ), rating each question (below) on a scale of 0-4 (0- never, 4- all the time).

Here are the questions in the IEQ:
  • I am suffering because of someone else’s negligence
  • It all seems so unfair 
  • Nothing will ever make up for what I have gone through
  • I feel as if I have been robbed of something very precious
  • I am troubled by fears that I may never achieve my dreams 
  • I can’t believe this has happened to me 
  • Most people don’t understand how severe my condition is 
  • My life will never be the same 
  • No one should have to live this way 
  • I just want my life back 
  • I feel that this has affected me in a permanent way
  • I worry that my condition is not being taken seriously
Then, the researchers took the results of this IEQ, and looked to see if there was any correlation with factors such as; depression, disability, return to work and pain levels.  They found that the subjects with higher IEQ scores were strongly correlated with the following:
  • An increase in catastrophic thinking (i.e. ruminating, exaggerating, thinking of worst-case scenarios)
  • Fear of movement and re-injury 
  • Higher levels of depression
  • Higher pain severity
  • The IEQ could even predict how quickly the subjects returned to work.  

If you're injured, take a look at the above questions in the IEQ- are you applying a score of 3 or 4 to many or most of them?  If you are, there's no doubting that you are angry, and feel as though what has happened is unfair. Unfortunately, this also means that you are more likely to be depressed, to feel more pain, and to have a slower return to work (compared to somebody with the same injury and a lower IEQ score). 

At the end of the day, if you are injured as a result of somebody else's negligence, it is completely normal to relate to some of the questions in the IEQ.  However, when too much focus is on being angry and getting even, the research is clear: we stay angry and we do not heal.  

How do we get better as quickly as possible?  There is no doubt that more than the body matters when recovering from injury.  Our attitudes, emotions, and even perceptions of pain also must be addressed to maximize recovery time.  

So to get better as quickly as possible, my advice is simple: focus on moving on, focus on healing, believe you will get better, and work toward living a life that makes you happy.

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