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Related Experiment Videos

Fibromyalgia: can one distinguish it from simulation? An observer-blind controlled study.

I Khostanteen1, E R Tunks, C H Goldsmith

  • 1Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

The Journal of Rheumatology
|November 28, 2000
PubMed
Summary
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Researchers assessed the accuracy of diagnosing fibromyalgia (FM) in patients versus healthy individuals and those simulating the condition. While examiners achieved 80% accuracy, distinguishing between FM and simulators remains challenging.

Area of Science:

  • Rheumatology
  • Clinical Diagnosis
  • Psychosomatic Medicine

Background:

  • Fibromyalgia (FM) diagnosis relies on clinical criteria, but distinguishing genuine cases from malingering can be difficult.
  • Previous studies have explored the reliability of diagnostic methods, but few have specifically investigated motivated simulation under blinded conditions.

Purpose of the Study:

  • To evaluate the diagnostic accuracy and reliability of identifying fibromyalgia (FM) in patients compared to healthy controls and financially motivated simulators.
  • To assess the effectiveness of tender point counts and illness behavior ratings in differentiating these groups.

Main Methods:

  • A randomized controlled trial involving 8 female subjects with chronic FM and 19 healthy female volunteers.
  • Volunteers were randomized into a 'simulator' group (paid to feign FM) or a 'normal control' group.

Related Experiment Videos

  • Blinded examiners assessed tender points, control points, and illness behavior; grip strength and self-rated pain were also measured.

    • Main Results:

    • Tender point counts significantly discriminated between the three groups (FM, simulators, normal controls).
    • Examiners achieved 80% accuracy in distinguishing FM from simulators and normals, with a significant kappa value of 0.69.
    • However, simulators were misidentified as FM in 33% of cases, and FM patients were misidentified as simulators in 20% of cases.

    Conclusions:

    • Blinded examiners can distinguish chronic FM, normal individuals, and motivated simulators with 80% accuracy using established criteria and bedside observations.
    • Tender point counts demonstrated good agreement and reliability.
    • The study does not offer a definitive 'test for malingering,' as a significant minority of both simulators and FM patients were misidentified.