• Joseph L Etherton, Kevin J Bianchini, Megan A Ciota, Matthew T Heinly, and Kevin W Greve.
• Department of Psychology, Loyola University, 6363 St. Charles Avenue, New Orleans, Louisiana 70118, USA.
• Spine J. 2006 Jan 1; 6 (1): 61-71.

Background ContextPain patients often report cognitive symptoms, and many will include them in their claims of disability. There is empirical evidence that patients with pain do experience problems on attention-demanding cognitive tasks, but the results are mixed and the potential impact of exaggeration in the context of pain-related litigation has not been addressed.Purpose1) Examine the impact of pain and malingering on attention; 2) determine if the Working Memory Index (WMI) of the Wechsler Adult Intelligence Scale-3 (WAIS-III) can reliably detect malingering.Study Design/SettingStudy 1: simulator design; Study 2: clinical known-groups design.Patient SampleStudy 1 used healthy college students; Study 2 used chronic pain patients and neurological patients.Outcome MeasuresThe WMI and its constituent subtests.MethodsStudy 1: College students were administered the WMI under three conditions: standard administration, with cold-pressor induced pain, or with instructions to simulate impairment due to pain. Study 2: Known-groups design in which the WMI was examined in non-malingering and definite malingering chronic pain patients, non-malingering moderate-severe traumatic brain injury, and memory disorder patients seen for routine psychological evaluation. Malingering was operationalized using published criteria.ResultsThere were no group differences in WMI or its subtests among non-malingering groups, but some individual clinical patients with pain did score at a level suggestive of attentional impairment. The lowest scores were found in the simulated malingering college students and definite malingering clinical pain groups, in which about half scored worse than 95% of the non-malingering clinical patients.ConclusionsThis study demonstrated that even when controlling for exaggeration some pain patients do exhibit problems with attentional function. However, significant impairment in WMI performance (eg, index score

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