Strategies for assessing pain and pain exaggeration: controlled studies

Area of Science:

• Rheumatology
• Pain Medicine
• Clinical Psychology

Background:

• Distinguishing genuine pain from exaggerated pain is crucial for accurate diagnosis and treatment in rheumatology.
• Current methods for assessing pain behavior may lack the sensitivity to detect subtle deception.

Purpose of the Study:

• To compare structured versus intuitive methods for detecting exaggerated pain behavior in two randomized studies.
• To evaluate the properties of relative tenderness measures as surrogates for pain assessment.

Main Methods:

• Experienced rheumatologists assessed pain and behavior in subjects instructed to either respond honestly or feign exaggerated tenderness.
• Study 1 used descriptive assessments, while Study 2 employed a prestructured format for behavior assessment.
• An algorithm was developed to analyze recorded data and compare it with examiner performance in detecting deception (Acting).

Main Results:

• Exaggerating pain allowed nontender patients to meet formal American College of Rheumatology (ACR) criteria for fibromyalgia.
• The structured pain behavior assessment in Study 2 improved sensitivity in detecting deception from 60% to 90% (p = 0.0003).
• Specificity remained high in both studies, with false positive diagnoses of deception being uncommon (85-86%).

Conclusions:

• Formal, numerical techniques are necessary for accurately assessing chronic pain.
• These methods can feasibly separate the structural and psychogenic components of chronic pain.
• Structured assessments enhance the reliability of pain behavior evaluation in clinical settings.