Assessing Malingering in Chronic Pain Patients – Conceptual & Practical Challenges
- RRS Education
Chronic Pain (CP) is an incredibly costly condition affecting approximately 20-40% of adults. In many cases, the diagnosis of chronic pain and resultant disability cannot be objectively measured and is based almost entirely on subjective patient reporting. Because of the inherent subjectivity of the pain experience, patients are often suspected of malingering, or intentionally exaggerating symptoms for personal gain.
The DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) defines malingering as “the intentional production of false of grossly exaggerated incentives such as financial compensation, military leave or medications.” It is important to note that the DSM does not classify malingering as a psychiatric disease, but as a potential focus of clinical attention. The DSM further states that malingering can be suspected when there a combination of: 1) a medicolegal context; 2) a discrepancy between self-report and objective findings; 3) poor cooperation in assessment and treatment; and 4) when antisocial personality disorder is present. The estimated prevalence of malingering in chronic pain cases in the context of financial incentives is as high as 20-50%!
There are currently 4 methods of identifying intentional exaggeration of symptoms, including behavioural signs, functional capacity evaluations (FCE’s) to assess effort bias, pen and paper questionnaires and symptom validity tests. With this being said, identifying malingering in the context of chronic pain is complex. These complexities will be discussed in this week’s Research Review…LOG IN OR SUBSCRIBE TO ACCESS THIS REVIEW!
THIS WEEK'S RESEARCH REVIEW: "Assessing Malingering in Chronic Pain Patients – Conceptual & Practical Challenges”
This paper was published in the Journal of Pain (2019) and this Review is posted in Recent Reviews, Pain - Biopsychosocial Model, Clinical Testing & Procedures and the 2020 Archive.