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. 2025 Jun 19:18:3077-3085.
doi: 10.2147/JPR.S518357. eCollection 2025.

The Mediating Role of Depression in the Relationship Between Perceived Injustice and Pain Intensity Among Fibromyalgia Patients

Sheer Raev  1 , Valerie Aloush  2   3 , Gadi Gilam  4 , Odelia Elkana  1
Affiliations

The Mediating Role of Depression in the Relationship Between Perceived Injustice and Pain Intensity Among Fibromyalgia Patients

Sheer Raev et al. J Pain Res. .

Abstract

Background: Fibromyalgia (FM) patients often perceive heightened levels of injustice, which can be associated with depressive symptoms. Despite this connection, the mediating role of depression between perceived injustice and pain intensity in FM patients remains unexplored.

Aim: This study explored whether depression mediates the relationship between perceived injustice and pain intensity in FM.

Methods: Data were collected through an online survey distributed to FM patients at the Tel Aviv Sourasky Medical Center, Israel. A total of 161 FM patients completed the survey, with perceived injustice assessed using the Injustice Experience Questionnaire, depression evaluated using the Patient Health Questionnaire, and pain intensity measured with the numerical Pain Intensity Rating Scale. Statistical analyses included analysis of variance and bootstrap-based mediation models.

Results: FM patients reported elevated levels of pain, perceived injustice, and depression. The study found that depression significantly mediated the association between perceived injustice and pain intensity in FM patients (P < 0.001, CI = 0.024, 0.312).

Conclusion: The link between perceived injustice and pain intensity in FM is partially explained by the level of depression. Individuals with higher perceived injustice scores are more susceptible to depression, subsequently experiencing increased pain. These findings suggest that intervention programs targeting depression may mitigate the impact of perceived injustice on pain intensity in FM, potentially enhancing health-related quality of life.

Keywords: depression; fibromyalgia; injustice experience questionnaire; pain intensity; perceived injustice; psychological distress.

Plain language summary

This study explores the connection between feelings of unfairness, depression, and pain levels in people with fibromyalgia, a chronic condition that causes widespread pain and emotional distress. Fibromyalgia patients often report experiencing a sense of injustice, such as feeling misunderstood or treated unfairly, which can worsen their mental and physical health. We aimed to investigate whether depression plays a role in linking perceived injustice to the intensity of pain experienced by these patients. To do this, we surveyed 161 individuals with fibromyalgia using online questionnaires. Participants rated their feelings of injustice, symptoms of depression, and pain intensity. Statistical methods were used to analyze how these factors interact. Our findings showed that people who felt a higher sense of injustice were more likely to experience symptoms of depression. This depression, in turn, contributed to higher levels of pain. In other words, depression served as a bridge connecting feelings of injustice to increased pain intensity. These results highlight the importance of addressing depression in fibromyalgia treatment. By helping patients manage depressive symptoms, healthcare providers may reduce the impact of perceived injustice on pain, potentially improving patients’ quality of life. This study emphasizes the need for psychological interventions to complement traditional pain management strategies for fibromyalgia patients. By understanding how mental health influences physical pain, this research supports a more comprehensive approach to care for people living with fibromyalgia.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Mediation model showing that depression partially mediates the relationship between perceived injustice (IEQ) and pain intensity. All paths were significant ( < 0.05; p < 0.001). Bootstrap sample = 10,000.
See this image and copyright information in PMC

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