Abstract
Chronic pain is a prevalent and costly condition, with many patients receiving income
support and funded treatment. Given that pain cannot be assessed objectively, patients
may be suspected of exaggerating their pain and disability to receive additional funding.
Although numerous methods of detecting malingering have been suggested, it is unclear
whether clinicians can reliably identify malingering in patients with chronic pain.
The present focus article was developed to assess the theoretical basis and empirical
support for proposed methods of detecting malingering in patients with chronic pain.
Five approaches were identified: the evaluation of behavioral signs, effort testing,
pen and paper measures, symptom validity tests, and combined methods. An examination
of the literature revealed that proposed assessment tools have little theoretical
basis or empirical support in patients with chronic pain. Additionally, assessment
tools are inconsistent with advances in pain science and scores or observations are
likely to be influenced by the typical features of chronic pain, including fear-avoidance
and central sensitization. Clinicians should be aware that as yet neither subjective
clinical opinions nor clinical detection methods can reliably identify malingering
in patients with chronic pain.
Perspective: There is interest in the development of assessment tools to detect malingering
in patients with chronic pain. An evaluation of methods reveals theoretical and empirical
limitations that undermine the usefulness of these approaches. As yet, there is no
reliable way for clinicians to identify malingering in patients with chronic pain.
Key words
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Article info
Publication history
Published online: July 20, 2018
Accepted:
July 6,
2018
Received in revised form:
June 30,
2018
Received:
March 29,
2018
Footnotes
The authors have no conflicts of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All authors have contributed substantially to the manuscript.
Identification
Copyright
© 2018 by the American Pain Society
