Physiotherapy Specialist, University of Otago, Kaiapoi, NZ
Tuck, N. L., Johnson, M. H., The Auckland Regional Pain Service (TARPS), Greenlane Clinical Center, NZ;
Bean, D. J., The University of Auckland, Auckland, NZ
Introduction: Chronic pain is a prevalent and costly condition, with many patients receiving income support and funded treatment. Given that pain cannot be objectively assessed, patients may be suspected of exaggerating their pain and disability to receive additional funding. It has been suggested that clincians working in the field of chronic pain be alert to the possibility of malingering. Although numerous methods of detecting malingering have been proposed, it is unclear whether clinicians can reliably identify malingering in patients with chronic pain.
Aim: To address the question of whether there are reliable methods for detecting malingering in patients with chronic pain in a clinical setting.
Methods: A review was conducted 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.
Results: Examination of the literature revealed that proposed assessment tools have little theoretical basis or empirical support for use 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.
Conclusions: Clinicians should be aware that as yet neither subjective opinions nor clinical assessment tools can reliably identify malingering in patients with chronic pain.