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Arch Phys Med Rehabil. 2009 Jul;90(7):1117-26. doi: 10.1016/j.apmr.2009.01.018.

Prevalence of malingering in patients with chronic pain referred for psychologic evaluation in a medico-legal context.

Author information

  • 1Department of Psychology, University of New Orleans, New Orleans LA 70148, USA. kgreve@uno.edu

Abstract

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.

PMID:
19577024
[PubMed - indexed for MEDLINE]
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