The Clinical journal of pain
-
This paper provides a philosophical, historical, and clinical analysis of exaggerated pain behavior, focusing on the nature of the standards used to judge behavior as exaggerated. Malingering is understood as a special case of exaggerated pain behavior. Drawing upon the work of philosopher Ludwig Wittgenstein and psychiatrist-anthropologist Horacio Fabrega, I argue that these standards are primarily moral rather than scientific in nature. ⋯ The highly variable relation between clinical pain and tissue damage, as well as the common problem of medically unexplained physical symptoms in primary care, pose serious challenges to this strategy of illness behavior validation. It will remain necessary to triage suffering presented to health care providers into that which should be addressed in the medical setting and that which is better addressed elsewhere. But we need to discard pseudoscientific reliance on medical tests and develop new standards that are openly acknowledged to be moral and social in nature.
-
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.
-
Comparative Study Clinical Trial
Factors predicting pain reduction in chronic back and neck pain after multimodal treatment.
To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. ⋯ Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.
-
Comparative Study Clinical Trial
Prognosis of multifactorial outcome in lumbar discectomy: a prospective longitudinal study investigating patients with disc prolapse.
Although previous research has shown that certain medical data and psychosocial factors predict postoperative pain, it remains unclear whether they also contribute to a more distinct outcome measure that is based on classification of self-reported outcome criteria. To assess the prognostic power of somatic, psychologic, and social predictors when evident outcome criteria of surgical treatment are investigated, this study used a prospective longitudinal design examining preoperative factors associated with outcome six months after lumbar discectomy. ⋯ Classification of patients regarding their individual outcome profiles showed that patients responded differently to lumbar disc-surgery. High risk factors for poor outcome of surgery are Laseque-sign and depression.