The Clinical journal of pain
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Malingering is not a diagnosis. It is a behavior for which there are no established diagnostic criteria. Guidelines have been published according to which malingering might be suspected, but those guidelines do not discriminate between patients who are malingering and ones with genuine sources of chronic pain. ⋯ Negative responses do not exclude a genuine complaint of pain, for patients may have a source of pain that is not amenable to testing with diagnostic blocks. Diagnostic blocks have proved particularly useful in the investigation of spinal pain for which the cause is not evident on conventional medical imaging. They can also confirm or refute purported mechanisms of certain clinical features in complex regional pain syndromes.
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Randomized Controlled Trial Comparative Study Clinical Trial
Detecting deception in facial expressions of pain: accuracy and training.
Clinicians tend to assign greater weight to nonverbal expression than to patient self-report when judging the location and severity of pain. However, patients can be successful at dissimulating facial expressions of pain, as posed expressions resemble genuine expressions in the frequency and intensity of pain-related facial actions. The present research examined individual differences in the ability to discriminate genuine and deceptive facial pain displays and whether different models of training in cues to deception would improve detection skills. ⋯ For each condition, the participants rated pain intensity and unpleasantness, decided which category each of the 4 video clips represented, and described cues they used to arrive at decisions. There were significant individual differences in accuracy, with females more accurate than males, but accuracy was unrelated to past pain experience, empathy, or the number or type of facial cues used. Immediate corrective feedback led to significant improvements in participants' detection accuracy, whereas there was no support for the use of an information-based training program.
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Over the past 20 years, there have been numerous attempts to identify methodologies that are capable of the determination of sincerity of effort during muscle testing. The ensuing paper reviewed this literature and drew several conclusions. Injured patients and healthy volunteers do produce less force and more variable force while performing submaximal contractions than maximal contractions. ⋯ Many studies have questionable or at least unknown generalizability to patient samples and actual functional capacity. It is critical that other explanatory variables such as fear of injury, pain, medications, work satisfaction, and other motivational factors be considered. It is our opinion that there is not sufficient empirical evidence to support the clinical application of muscle testing to determine sincerity of effort.
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Malingering--the willful, deliberate, and fraudulent feigning or exaggeration of illness--was originally described as a means of avoiding military service. In present-day clinical practice, malingering may occur in circumstances where the person wishes to avoid legal responsibility or in situations where compensation or some other benefit might be obtained. In law, the term malingering is used in relation to persons to whom military regulations apply; in other situations, malingering is regarded as fraud and may lead to charges of perjury or criminal fraud. ⋯ In this article, we will review the literature on pain and malingering and discuss attempts that have been made to develop methods and guidelines for the detection of malingered pain. There are, however, no valid clinical methods of assessment of possible malingering of pain. In our view, the ultimate issue of the veracity of the plaintiff is for the Court to decide, and epithets such as "malingerer" have no place in reports prepared for legal purposes by health care professionals.
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Self-report plays a primary but not exclusive role in pain assessment. As is true of all self-reported experiences, under certain circumstances, the report of chronic pain can be distorted and misrepresented. ⋯ The current paper provides a rationale for the use of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in the comprehensive assessment of chronic pain with an emphasis on the advantage the MMPI-2 provides in the detection of response bias or malingering. A critical review of available MMPI-2 validity scales is presented, and recommendations for use of these scales in the evaluation of patients with chronic pain are made.