Abstract
Greve KW, Ord JS, Bianchini KJ, Curtis KL. Prevalence of malingering in patients with
chronic pain referred for psychologic evaluation in a medico-legal context.
Objective
To provide an empirical estimate of the prevalence of malingered disability in patients
with chronic pain who have financial incentive to appear disabled.
Design
Retrospective review of cases.
Setting
A private neuropsychologic clinic in a southeastern metropolitan area.
Participants
Consecutive patients (N=508) referred for psychologic evaluation related to chronic
pain over a 10-year period (1995–2005).
Interventions
Not applicable.
Main Outcome Measures
Prevalence of malingering was examined using 2 published clinical diagnostic systems
(Malingered Pain-Related Disability and Malingered Neurocognitive Dysfunction) as
well as statistical estimates based on well validated indicators of malingering.
Results
The prevalence of malingering in patients with chronic pain with financial incentive
is between 20% and 50% depending on the diagnostic system used and the statistical
model's underlying assumptions. Some factors associated with the medico-legal context
such as the jurisdiction of a workers' compensation claim or attorney representation
were associated with slightly higher malingering rates.
Conclusions
Malingering is present in a sizable minority of patients with pain seen for potentially
compensable injuries. However, not all excess pain-related disability is a result
of malingering. It is important not to diagnose malingering reflexively on the basis
of limited or unreliable findings. A diagnosis of malingering should be explicitly
based on a formal diagnostic system.
Key Words
List of Abbreviations:
CI (confidence interval), CVLT (California Verbal Learning Test), FCE (Functional Capacity Evaluation), MMPI-2 (Minnesota Multiphasic Personality Inventory-2), MND (Malingered Neurocognitive Dysfunction), MPRD (Malingered Pain-Related Disability), PDRT (Portland Digit Recognition Test), TBI (traumatic brain injury), TOMM (Test of Memory Malingering), WAIS-III (Wechsler Adult Intelligence Scale-III)To read this article in full you will need to make a payment
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Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
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© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
