AB083. SOH21AS001. Perceived injustice and the therapeutic alliance in chronic pain: a systematic review

Background: The negative role of perceived injustice and anger in chronic pain has been described However, there is a poor understanding of the impact of perceived injustice and anger on the therapeutic alliance in this setting. This study aims to review the current literature examining perceived injustice and anger and their impact on the therapeutic alliance in the context of chronic pain.

Methods: In July 2020, a search was carried out of electronic databases (Academic Search Complete, AMED, Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus). Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using PRISMA guidelines for systematic reviews.

Results: The initial search yielded 255 results. After duplicates were removed and inclusion and exclusion criteria applied, there were three papers to be reviewed. In total 225 patients were analysed. Of the papers reviewed, all showed a negative correlation between anger expression and patient rating of the therapeutic alliance. Poor therapeutic alliance was associated with increased perceived injustice and anger expression. Anger expression is the mediator of the proposed perceived injustice and therapeutic alliance relationship.

Conclusions: The review highlights the potential role of anger in the modulation of the therapeutic alliance. Injustice should be assessed in all new chronic pain patients and doctors should be aware of its implications for therapeutic alliance. The review provokes the need for further research on the topic which could lead to potential therapeutic interventions.

Keywords: Anaesthesia; anger; chronic pain; perceived injustice; therapeutic alliance