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Chronic pain disability exaggeration/malingering and submaximal effort research
D A Fishbain1, R Cutler, H L Rosomoff
1Department of Psychiatry, University of Miami, School of Medicine, Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami Beach, Florida 33139, USA.
The Clinical Journal of Pain
|January 5, 2000
Summary
Malingering occurs in chronic pain patients, but current detection methods are unreliable. Isokinetic strength testing shows potential for identifying deceptive pain behaviors in clinical settings.
Area of Science:
- Pain Management
- Forensic Psychology
- Clinical Research Methodology
Background:
- Malingering, or disease simulation, is a complex issue in chronic pain management.
- Understanding the prevalence and detection of malingering in chronic pain patients (CPPs) is crucial for accurate diagnosis and treatment.
- This review is the first to systematically examine research on malingering within the chronic pain context.
Purpose of the Study:
- To determine the prevalence of malingering among chronic pain patients.
- To assess the existing evidence for reliable detection methods of malingering in CPPs.
- To identify future research directions for malingering detection in chronic pain.
Main Methods:
- A comprehensive literature search identified 328 relevant articles, with 68 focusing on malingering and pain.
- Articles were categorized into 12 topic areas, including prevalence, detection methods (questionnaires, strength testing), and symptom magnification.
- Study quality was rated using Agency for Health Care Policy and Research (AHCPR) guidelines to assess the strength of evidence.
Main Results:
- Malingering and dissimulation are present in chronic pain settings, with estimated prevalence ranging from 1.25% to 10.4%, though these figures lack reliability due to poor study quality.
- Current methods like facial expression analysis, questionnaires, sensory testing, and clinical examination are unreliable for detecting malingering.
- Isometric strength testing and coefficient of variation methods were also found to be unreliable, while isokinetic strength testing demonstrated potential for discriminating between genuine and malingered efforts.
Conclusions:
- Existing data on malingering prevalence in chronic pain patients is inconsistent, precluding definitive conclusions.
- There is currently no consistently reliable method for detecting malingering in chronic pain patients.
- Isokinetic strength testing shows promise as a detection method, but claims of definitive malingering identification should be approached with caution.