K. Bianchini

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.

Serial assessments are now common in neuropsychological practice, and have a recognized value in numerous clinical and forensic settings. These assessments can aid in differential diagnosis, tracking neuropsychological strengths and weaknesses over time, and managing various neurologic and psychiatric conditions. This document provides a discussion of the benefits and challenges of serial neuropsychological testing in the context of clinical and forensic assessments. Recommendations regarding the use of repeated testing in neuropsychological practice are provided.

Pain patients often report cognitive symptoms and many will include them in their claims of disability. The Processing Speed Index (PSI) of the WAIS-III was investigated as one aspect of cognitive functioning in six groups. Slight impairment was found for PSI and Digit Symbol subtest performance, but not for Symbol Search, in a Laboratory-induced Pain group and a Clinical Pain group. The lowest scores were found in a Simulator group instructed to fake cognitive impairment and a Clinical Pain group diagnosed as Malingering. Results suggest that PSI scores are only slightly reduced by laboratory-induced pain or chronic pain, and that unexpectedly low scores in the absence of significant/documented brain dysfunction suggest poor effort or deliberate misrepresentation.

The purpose of this study was to determine the accuracy of Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity indicators in the detection of malingering in clinical patients with chronic pain using a hybrid clinical-known groups/simulator design. The sample consisted of patients without financial incentive ( n = 23), nonmalingering patients with financial incentive ( n = 34), patients definitively determined to be malingering based on published criteria ( n = 32), and college students asked to simulate pain-related disability ( n = 26). The MMPI-2 validity scales differentiated malingerers from nonmalingerers with a high degree of accuracy. Hypochondriasis and Hysteria were also effective. For all variables except Scale L, more extreme scores were associated with higher specificity. This study demonstrates that the MMPI-2 is capable of differentiating intentional exaggeration from the effects on symptom re...

The reliable digit span (RDS) performance of chronic pain patients with unambiguous spinal injuries and no evidence of exaggeration or response bias (n = 53) was compared to that of chronic pain patients meeting criteria for definite malingered neurocognitive dysfunction (n = 35), and a group of nonmalingering moderate-severe traumatic brain injury (TBI) patients (n = 69). The results demonstrated that scores of 7 or lower were associated with high specificity (> .90) and sensitivity (up to .60) even when moderate to severe TBI are included. Multiple studies have demonstrated that RDS scores of 7 or lower rarely occur in TBI and pain patients who are not intentionally performing poorly on cognitive testing. This study supports the use of the RDS in detecting response bias in neuropsychological patients complaining of pain as well as in the assessment of pain-related cognitive impairment in patients whose primary complaint is pain.

Reliable Digit Span (RDS) is an indicator used to assess the validity of cognitive test performance. Scores of 7 or lower suggest poor effort or negative response bias. The possibility that RDS scores are also affected by pain has not been addressed thus potentially threatening RDS specificity. The current study used cold pressor-induced pain to investigate the effect of pain on RDS scores. Sixty undergraduate volunteers randomly assigned to one of three conditions (control, simulator, pain) completed the Digit Span subtest from the Wechsler Adult Intelligence Scale-III from which the RDS is derived. No differences in RDS scores were found between the control and pain groups, and neither group scored below 8. Sixty-five percent of the simulator group scored 7 or below. These results suggest that RDS is not affected by pain, and scores of 7 or less in persons with pain can be more confidently attributed to negative response bias.