Cognitive appraisal processes mediate postinjury pain and disability: A longitudinal observational study

Psychological appraisal processes of pain catastrophizing (PC) and perceived injustice (PI) are involved in the transition to postinjury disability. Although these factors are modifiable and may serve as ideal intervention targets to improve recovery, they have not been examined as mediators between acute pain and postinjury disability. The present study utilized longitudinal mediation to examine acute PC and PI as mechanisms by which acute pain contributes to 90-day disability in adults after a motor vehicle crash.

This study represents secondary data analysis of a null randomized controlled trial. In total, 47 emergency department patients (M_age = 37 years; 64% female) completed an assessment within 24 hr postinjury, and 30-day and 90-day follow-up assessments on postinjury PC, PI, and disability. We utilized longitudinal mediation models to estimate direct and indirect effects adjusted for age, sex, preinjury disability, and intervention.

Higher levels of PI and PC were associated with greater disability. There was a statistically significant indirect effect for PC and PI, suggesting that the relationship between emergency department pain and 90-day disability was partially explained by these psychological appraisal mechanisms.

Patients at risk for postinjury disability display higher levels of PC, in the form of rumination, feeling helpless, or magnifying their pain, and higher levels of PI, via blaming others for their situation. Future work is warranted to determine whether interventions targeting these mechanisms may help improve long-term postinjury recovery. (PsycInfo Database Record (c) 2026 APA, all rights reserved).