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Malingering: Chronic Pain

  • Keith Nicholson
  • Michael F. Martelli

Abstract

Mendelson and Mendelson (2004) suggest that medical examiners most often suspect malingering in the context of assessing chronic pain. There has long been concern about whether pain may be “real” or feigned. Thomas (1923) thought headache was the most frequent clinical pain problem and the most difficult to detect if feigned. A number of techniques to identify malingerers were suggested, extended observation being considered to be the most reliable. Collie (1932), in an influential work entitled “Fraud in Medico-Legal Practice,” thought that back pain was the most common complaint in cases where compensation was being claimed. However, such pain was thought to be usually mental rather than physical, reflecting the problem of mind-body dualism (Nicholson, Martelli, & Zasler, 2002).

Keywords

Chronic Pain Facial Expression Pain Patient Pain Behavior Chronic Pain Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Apkarian, A. V., Bushnell, M. C., Treede, R. D., & Zubieta, J. K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain, 9, 463–484. Epub.PubMedCrossRefGoogle Scholar
  2. Arbisi, P. A., & Butcher, J. N. (2004). Psychometric perspectives on detection of malingering of pain: Use of the Minnesota Multiphasic Personality Inventory-2. Clinical Journal of Pain, 20, 383–391.PubMedCrossRefGoogle Scholar
  3. Basbaum, A. I. (1999). Spinal mechanisms of acute and persistent pain. Regional Anesthesia and Pain Medicine, 24, 59–67.PubMedCrossRefGoogle Scholar
  4. Bianchini, K. J., Greve, K. W., & Glynn, G. (2005). On the diagnosis of malingered pain-related disability: Lessons from cognitive malingering research. The Spine Journal, 5, 404–417.PubMedCrossRefGoogle Scholar
  5. Bogduk, N. (2004). Diagnostic blocks: A truth serum for malingering. Clinical Journal of Pain, 20, 409–414.PubMedCrossRefGoogle Scholar
  6. Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). Minnesota Multiphasic Personality Inventory (MMPI-2): Manual for administration and scoring. Minneapolis: University of Minnesota Press.Google Scholar
  7. Byrne, R. W., & Stokes, E. (2003). Can monkeys malinger? In P. W. Halligan, C. Bass, & D. A. Oakley (Eds.), Malingering and illness deception (pp. 54–67). New York: Oxford University Press.Google Scholar
  8. Chapman, C. R., Donaldson, G. W., Nakamura, Y., Jacobson, R. C., Bradshaw, D. H., & Gavrin, J. (2002). A psychophysiological causal model of pain report validity. The Journal of Pain, 3, 143–155.PubMedCrossRefGoogle Scholar
  9. Chaytor, N., & Schmitter-Edgecombe, M. (2003). The ecological validity of neuropsychological tests: A review of the literature on everyday cognitive skills. Neuropsychology Review, 4, 181–197.CrossRefGoogle Scholar
  10. Clark, W. C. (1994). The psyche in the psychophysics of pain: An introduction to sensory decision theory. In J. Boivie, P. Hansson, & U. Lindblom (Eds.), Touch, temperature and pain in health and disease: Mechanisms and assessments. Progress in Pain Research and Management, Vol 3. Seattle: IASP Press.Google Scholar
  11. Clayer, J. R., Bookless, C., & Ross, M.W. (1984). Neurosis and conscious symptom exaggeration: Its differentiation by the Illness Behavior Questionnaire. Journal of Psychosomatic Research, 28, 237–241.PubMedCrossRefGoogle Scholar
  12. Clayer, J. R., Bookless, C., & Ross, M. W. (1986). The evaluation of illness behavior and exaggeration of disability. British Journal of Psychiatry, 148, 296–299.PubMedCrossRefGoogle Scholar
  13. Collie, J. (1932). Fraud in medico-legal practice. London: Edward Arnold & Co.Google Scholar
  14. Craig, K. D., Hyde, S. A., & Patrick, C. J. (1991). Genuine, suppressed and faked facial behavior during exacerbation of chronic low back pain. Pain, 46, 161–71.PubMedCrossRefGoogle Scholar
  15. Crowne, D., & Marlow, D. (1960). A new scale of social desirability, independent of psychopathology. Journal of Consulting Psychology, 24, 349–354.PubMedCrossRefGoogle Scholar
  16. Denollet, J. (1991). Negative affectivity and repressive coping: Pervasive influence on self-reported mood, health, and coronary-prone behavior. Psychosomatic Medicine, 53, 538–556.PubMedGoogle Scholar
  17. Deshields, T. L., Tait, R. C., Gfeller, J. D., & Chibnall, J. T. (1995). Relationship between social desirability and self-report in chronic pain patients. The Clinical Journal of Pain, 11, 189–193.PubMedCrossRefGoogle Scholar
  18. Derogatis, L. R. (1983). SCL-90-R: Administration, scoring and procedures manual-II. Towson: Clinical Psychometric Research.Google Scholar
  19. Dush, D. M., Simons, L. E., Platt, M. et al. (1994). Psychological profiles distinguishing litigating and nonlitigating pain patients: Subtle, and not so subtle. Journal of Personality Assessment, 62, 299–313.PubMedCrossRefGoogle Scholar
  20. Epstein, R. M., Quill, T. E., & McWhinney, I. R. (1999). Somatization reconsidered: Incorporating the patient’s experience of illness. Annals of Internal Medicine, 159, 215–222.CrossRefGoogle Scholar
  21. Etherton, J. L., Bianchini, K. J., Ciota, M. A., Heinly, M. T., & Greve, K. W. (2006). Pain, malingering and the WAIS-III Working Memory Index. The Spine Journal, 6, 61–71.PubMedCrossRefGoogle Scholar
  22. Etherton, J. L., Bianchini, K. J., Greve, K. W., & Heinly, M. T. (2005). Sensitivity and specificity of Reliable Digit Span in malingered pain-related disability. Assessment, 12, 130–136.PubMedCrossRefGoogle Scholar
  23. Fernandez, E., & Turk, D. C. (1992). Sensory and affective components of pain: Separation and synthesis. Psychological Bulletin, 112, 205–217.PubMedCrossRefGoogle Scholar
  24. Fishbain, D. A., Cole, B., Cutler, R. B., Lewis, J., Rosomoff, H. L., & Rosomoff, R. S. (2003). A structured evidence based review on the meaning of non-organic physical signs: Waddell signs. Pain Medicine, 4, 141–181.PubMedCrossRefGoogle Scholar
  25. Fishbain, D. A., Cutler, R. B., Lewis, J., Cole, B., Steele-Rosomoff, R., & Rosomoff, H. L. (2003). Is the location of nondermatomal sensory abnormalities (NDSAs) related to pain location? Pain Medicine, 4, 248–253.Google Scholar
  26. Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff, R. S. (1999). Chronic pain disability exaggeration/malingering and submaximal effort research. Clinical Journal of Pain, 15, 244–274.PubMedCrossRefGoogle Scholar
  27. Fishbain, D. A., Cutler, R. B., Rosomoff, H. L., & Steele-Rosomoff, R. (2002). Does the conscious exaggeration scale detect deception within patients with chronic pain alleged to have secondary gain? Pain Medicine, 3, 39–46.PubMedCrossRefGoogle Scholar
  28. Fishbain, D A., Cutler, R. B., Rosomoff, H. L., & Rosomoff, R. S. (2004). Is there a relationship between nonorganic physical findings (Waddell Signs) and secondary gain/malingering? Clinical Journal of Pain, 20, 399–408.PubMedCrossRefGoogle Scholar
  29. Fishbain, D. A., Goldberg, M., Meagher, R. B., Steele, R., & Rosomoff, H. (1986). Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain, 26, 181–97.PubMedCrossRefGoogle Scholar
  30. Flor, H. (2002). The modification of cortical reorganization and chronic pain by sensory feedback. Applied Psychophysiology and Biofeedback, 27, 215–227.PubMedCrossRefGoogle Scholar
  31. Fordyce, W. E. (1976). Behavioral methods for chronic pain and illness. St. Louis, MO: Mosby.Google Scholar
  32. Gervais, R., Green, P., Allen, M., & Iverson, G. (2001). Effects of coaching on symptom validity testing in chronic pain patients presenting for disability assessments. Journal of Forensic Neuropsychology, 2, 1–19.CrossRefGoogle Scholar
  33. Gracely, R. H., Geisser, M. E., Giesecke, T., Grant, M. A. B., Petzke, F., Williams, D. A. et al. (2004). Pain catastrophizing and neural responses to pain among persons with Fibromyalgia. Brain, 127, 835–843.PubMedCrossRefGoogle Scholar
  34. Green, D. M., & Swets, J. A. (1966). Signal detection theory and psychophysics. New York: Wiley.Google Scholar
  35. Greve, K. W., Bianchini, K. J., & Ameduri, C. J. (2003a). Use of a forced-choice test of tactile discrimination in the evaluation of functional sensory loss: A report of 3 cases. Archives of Physical Medicine and Rehabilitation, 84, 1233–1236.PubMedCrossRefGoogle Scholar
  36. Hadjistavropoulos, H. D., & Craig, K. D. (1994). Acute and chronic low back pain: Cognitive, affective and behavioral dimensions. Journal of Consulting and Clinical Psychology, 62, 341–349.PubMedCrossRefGoogle Scholar
  37. Hadjistavropoulos, H.D., Craig, K.D., Hadjistavropoulos, T., & Poole, G.D. (1996). Subjective judgments of deception in pain expression: Accuracy and errors. Pain, 65, 251–258.PubMedCrossRefGoogle Scholar
  38. Harness, D. M., & Chase, P. F. (1994). Litigation and chronic facial pain. Journal of Orofacial Pain, 8, 289–292.PubMedGoogle Scholar
  39. Hathaway, S. R., & McKinley, J. C. (1967). Minnesota Multiphasic Personality Inventory manual. New York: Psychological Corporation.Google Scholar
  40. Hill, M. L., & Craig, K. D. (2004). Detecting deception in facial expressions of pain: Accuracy and training. Clinical Journal of Pain, 20, 415–422.PubMedCrossRefGoogle Scholar
  41. Jamner, L. D., & Leigh, H. (1999). Repressive/defensive coping, endogenous opioids and health: How a life so perfect can make you sick. Psychiatry Research, 85, 17–31.PubMedCrossRefGoogle Scholar
  42. Keller, L. S., & Butcher, J. N. (1991). Assessment of Chronic Pain Patients with the MMPI-2. MMPI-2 Monographs. Minneapolis: University of Minnesota Press.Google Scholar
  43. Kirmayer, L. J., & Robbins, J. M. (1996). Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychological Medicine, 26, 937–951.PubMedCrossRefGoogle Scholar
  44. Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, 262–266.PubMedCrossRefGoogle Scholar
  45. Leavitt, F. (1985). Pain and deception: Use of verbal pain measurement as a diagnostic aid in differentiating between clinical and simulated low-back pain. Journal of Psychosomatic Research, 29, 495–505.PubMedCrossRefGoogle Scholar
  46. Leavitt, F. (1987). Detection of simulation among persons instructed to exaggerate symptoms of low back pain. Journal of Occupational Medicine, 29, 229–233.PubMedGoogle Scholar
  47. Leavitt, F. (1991). Predicting disability time using formal low back pain measurement: The Low Back Pain Simulation Scale. Journal of Psychosomatic Research, 35, 599–607.PubMedCrossRefGoogle Scholar
  48. Leavitt, F., Garron, D. C., D’angelo, C. M., & MCneill, T. W. (1979). Low back pain in patients with and without demonstrable organic disease. Pain, 6, 191–200.PubMedCrossRefGoogle Scholar
  49. Mailis, A., Giannoylis, I., Downar, J., Kwan, C., Mikulis, D., Crawley, A. et al. (2003). Altered central somatosensory processing in chronic pain patients with “hysterical” anaesthesia. Neurology, 60, 1501–1507.Google Scholar
  50. Mailis, A., & Nicholson, K. (2002). The use of sodium amytal in the assessment and treatment of functional or other disorders. In N. D. Zasler, & M. F. Martelli (Eds.), Functional medical disorders, state of the art reviews in physical medicine and rehabilitation (pp. 131–146). Philadelphia: Hanley & Belfus.Google Scholar
  51. Mailis, A., Papagapiou, M., Umana, M., Cohodarevic, T., Nowak, J., & Nicholson, K. (2001). Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors? Journal of Rheumatology, 28, 1385–1393.PubMedGoogle Scholar
  52. Main, C. J., & Waddell, G. (1998). Behavioral responses to examination. A reappraisal of the interpretation of “nonorganic signs.” Spine, 23, 2367–2371.PubMedCrossRefGoogle Scholar
  53. Martelli, M. F., Nicholson, K., Zasler, N. D., & Bender, M. C. (2006). Assessment of response bias in clinical and forensic evaluations of impairment following brain injury. In N. D. Zasler, D. I. Katz, & R. D. Zafonte (Eds.), Brain injury medicine: Principles and practice. New York: Demos Medical.Google Scholar
  54. Martelli, M. F., Zasler, N. D., Nicholson, K., Pickett, T. C., & May, V. R. (2002). Assessing the veracity of pain complaints and associated disability. In R. B. Weiner (Ed.), Pain management: A practical guide for clinicians (6th ed.) (pp. 789–805). Boca Ratan, FL: St. Lucie Press.Google Scholar
  55. McGuire, B. E., Harvey, A. G., & Shores, E. A. (2001). Simulated malingering in pain patients: A study with the Pain Patient Profile. British Journal of Clinical Psychology, 40, 71–79.PubMedCrossRefGoogle Scholar
  56. McGuire, B. E., & Shores, E.A. (2001a). Pain Patient Profile and the assessment of malingered pain. Journal of Clinical Psychology, 57, 401–409.PubMedCrossRefGoogle Scholar
  57. McGuire, B. E., & Shores, E.A. (2001b). Simulated pain on the Symptom Checklist 90-Revised. Journal of Clinical Psychology, 57, 1589–1596.PubMedCrossRefGoogle Scholar
  58. Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–279.PubMedCrossRefGoogle Scholar
  59. Melzack, R., Katz, J., & Jeans, M. E. (1985). The role of compensation in chronic pain: Analysis using a new method of scoring the McGill Pain Questionnaire. Pain, 23, 101–112.PubMedCrossRefGoogle Scholar
  60. Mendelson, G. (1987). Measurement of conscious symptom exaggeration by questionnaire: a clinical study. Journal of Psychosomatic Research, 31, 703–711.PubMedCrossRefGoogle Scholar
  61. Mendelson, G., & Mendelson, D. (2004). Malingering pain in the medicolegal context. Clinical Journal of Pain, 20, 423–432.PubMedCrossRefGoogle Scholar
  62. Meyers, J. E., Millis, S. R., & Volkert, K. (2002). A validity index for the MMPI-2. Archives of Clinical Neuropsychology, 17, 157–169.PubMedCrossRefGoogle Scholar
  63. Merskey, H., & Bogduk, N. (Eds.). (1994). Classification of chronic pain (2nd ed.). Seattle: IASP Press.Google Scholar
  64. Miller, L. (2000). Neurosensitization: A model for persistent disability in chronic pain, depression, and Posttraumatic Stress Disorder following injury. Neurorehabilitation, 14, 25–32.PubMedGoogle Scholar
  65. Millon, T. (1997). Millon clinical multiaxial inventory-III manual (2nd ed.). Minneapolis, MN: NCS Pearson.Google Scholar
  66. Nicholson, K. (2000). At the crossroads: Pain in the 21st Century. NeuroRehabilitation, 14, 57–67.PubMedGoogle Scholar
  67. Nicholson, K., & Mailis, A. (in preparation, a). MCMI profiles in a chronic pain population.Google Scholar
  68. Nicholson, K., & Mailis, A. (in preparation, b). Repression and sensitization in chronic pain patients.Google Scholar
  69. Nicholson, K., & Martelli, M. (2004). The problem of pain. Journal of Head Trauma Rehabilitation, 19, 2–9.PubMedGoogle Scholar
  70. Nicholson, K., Martelli, M. F., & Zasler, N. D. (2002). Myths and misconceptions about chronic pain: The problem of mind body dualism. In R. B. Weiner (Ed.), Pain management: A practical guide for clinicians (6th ed., pp. 465–474). Boca Raton, FL: St. Lucie Press.Google Scholar
  71. Pilowsky, I., & Spence, N. D. (1975). Patterns of illness behavior in patients with intractable pain. Journal of Psychosomatic Research, 19, 279–287.PubMedCrossRefGoogle Scholar
  72. Poole, G. D., & Craig, K. D. (1992). Judgments of genuine, suppressed and faked facial expressions of pain. Journal of Personality and Social Psychology, 63, 797–805.PubMedCrossRefGoogle Scholar
  73. Prkachin, K. M. (1992). The consistency of facial expressions of pain: A comparison across modalities. Pain, 51, 297–306.PubMedCrossRefGoogle Scholar
  74. Robinson, M. E., & Dannecker, E. A. (2004). Critical issues in the use of muscle testing for the determination of sincerity of effort. Clinical Journal of Pain, 20, 392–398.PubMedCrossRefGoogle Scholar
  75. Rollman, G. B. (1977). Signal detection theory measurement of pain: A review and critique. Pain, 3, 187–211.PubMedCrossRefGoogle Scholar
  76. Rollman, G. B. (1979). Signal detection theory measures: Empirical validation studies and adaptation-level effects. Pain, 6, 9–21.PubMedCrossRefGoogle Scholar
  77. Rondinelli, R. D., & Katz, R. T. (Eds.). (2000). Impairment rating and disability evaluation. Philadelphia, PA: W. B. Saunders.Google Scholar
  78. Salamy, J. G., Wolk, D. J., & Shucard, D. W. (1983). Psychophysiological assessment of statements about pain. Psychophysiology, 20, 579–584.PubMedCrossRefGoogle Scholar
  79. Sartori, G., Forti, S., Birbaumer, N., & Flor, H. (2003). A brief and unobtrusive instrument to detect simulation and exaggeration in patients with whiplash syndrome. Neuroscience Letters, 342, 53–56.PubMedCrossRefGoogle Scholar
  80. Schmand, B., Lindeboom, J., Schagen, S., Heijt, R., Koene, T., & Hamburger, H. L. (1998). Cognitive complaints in patients after whiplash injury: The impact of malingering. Journal of Neurology, Neurosurgery, and Psychiatry, 64, 339–343.PubMedCrossRefGoogle Scholar
  81. Shoichet, R. P. (1978). Sodium amytal in the diagnosis of chronic pain. Canadian Psychiatric Association Journal, 23, 219–228.PubMedGoogle Scholar
  82. Slesinger, D., Archer, R. P., & Duane, W. (2002). MMPI-2 characteristics in a chronic pain population. Assessment, 9, 406–414.PubMedCrossRefGoogle Scholar
  83. Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545–561.PubMedGoogle Scholar
  84. Sullivan, M. (2004). Exaggerated pain behavior: By what standard? Clinical Journal of Pain, 20, 433–439.PubMedCrossRefGoogle Scholar
  85. Thimineur, M., Kaliszewski, T., & Sood, P. (2000). Malingering and symptom magnification: A case report illustrating the limitations of clinical judgment. Connecticut Medicine, 64, 399–401.PubMedGoogle Scholar
  86. Thomas, J. J. (1923). Malingering and the feigned disorders. In F. Peterson, W. S. Haines, & R. W. Webster (Eds.), Legal medicine and toxicology (2nd ed., pp. 696–717). Philadelphia, PA: W. B. Saunders.Google Scholar
  87. Tollison, D. C., & Langley, J. C. (1995). Pain patient profile manual. Minneapolis, MN: National Computer Services.Google Scholar
  88. Tomaka, J., Blascovich, J., & Kelsey, R. M. (1992). Effects of self-deception, social desirability, and repressive coping on psychophysiological reactivity to stress. Personality and Social Psychology Bulletin, 18, 616–624.CrossRefGoogle Scholar
  89. Trabin, T., Rader, C., & Cummings, C. (1987). A comparison of pain management outcomes for disability compensation and non-compensation patients. Psychology and Health, 1, 341–351.Google Scholar
  90. Turk, D. C., & Melzack, R. (1993). The measurement of pain and the assessment of people experiencing pain. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 3–14). New York: Guilford Press.Google Scholar
  91. Vendrig, A. A. (2000). The Minnesota Multiphasic Personality Inventory and chronic pain: A conceptual analysis of a long-standing but complicated relationship. Clinical Psychology Review, 20, 533–559.PubMedCrossRefGoogle Scholar
  92. Vogt, B. A., Sikes, R. W., & Vogt, L. J. (1993). Anterior cingulate cortex and the medial pain system. In B. A. Vogt & M. Gabriel (Eds.), Neurobiology of cingulate cortex and limbic thalamus: A comprehensive handbook (pp. 313–344). Boston: Birkhauser.Google Scholar
  93. Waddell, G. (2004). The back pain revolution (2nd ed.). Edinburgh: Churchill Livingstone.Google Scholar
  94. Waddell, G., McCulloch, J. A., & Kimmel, E. (1980). Non-organic physical signs in low back pain. Spine, 5, 117–125.PubMedCrossRefGoogle Scholar
  95. Waddell, G., Main, C. J., & Morris, E. W. (1984). Chronic low back pain, psychologic distress and illness behavior. Spine, 9, 209–213. Library Holdings Bibliographic Links.PubMedCrossRefGoogle Scholar
  96. Wager, T. D., Rilling, J. K., Smith, E. E., Sokolik, A., Casey, K. L., Davidson, R. J. et al. (2004). Placebo-induced changes in FMRI in the anticipation and experience of pain. Science, 303, 1162–1167.PubMedCrossRefGoogle Scholar
  97. Wallis, B. J., & Bogduk, N. (1996). Faking a profile: Can naive subjects simulate whiplash responses? Pain, 66, 223–227.PubMedCrossRefGoogle Scholar
  98. Wechsler, D. A. (1997). Wechsler adult intelligence scale-III. New York: Psychological Corporation.Google Scholar
  99. Weinberger, D. A., & Schwartz, G. E. (1979). Low-anxious, high-anxious, and repressive coping styles: Psychometric patterns and behavioral and physiological response to stress. Journal of Abnormal Psychology, 88, 369–380.PubMedCrossRefGoogle Scholar
  100. Wickramasekera, I. E. (1995). Somatization: Concepts, data, and predictions from the high risk model of threat perception. The Journal of Nervous and Mental Disease, 83, 15–23.CrossRefGoogle Scholar
  101. Wittgenstein, L. (1980). Remarks on the philosophy of psychology. Chicago, IL: University of Chicago Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Keith Nicholson
    • 1
  • Michael F. Martelli
    • 2
  1. 1.Comprehensive Pain ProgramToronto Western HospitalToronto
  2. 2.Concussion Care Centre of VirginiaGlen Allen

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