Social justice appraisals refer to evaluations about fairness. These judgments are particularly pertinent in the experience of an undeserved fate, such as the suffering caused by a chronic health complaint. Published research examining the implications of these appraisals for adjustment to long-term painful conditions has emerged only recently, focused in two areas of investigation. One area shows that perceived injustice for pain may be a vulnerability factor that can block adjustment. The second area shows that maintaining some sense of justice in life, despite personal adversity, might protect psychological health when people are in pain. The review discusses this research and identifies key reactions to perceived injustice in the context of chronic pain. We call for investigations to synthesize this research, specifically to establish mediators and moderators of varied justice appraisals, to examine the relationships between core justice beliefs and injustice appraisals, and to identify drivers of responses to injustice. Finally, we consider interventions for those pain sufferers struggling to cope with perceived injustice.