Handbook of Pain Syndromes: Biopsychosocial Perspectives

By Andrew R. Block; Edwin F. Kremer et al. | Go to book overview

Chapter 3
Detecting Deception and Malingering

Kenneth D. Craig
Marilyn L. Hill
Bruce W. McMurtry
University of British Columbia

Ideally, this chapter would identify features of pain representations known to discriminate between subjective experiences of pain and claims that are falsified. Regrettably, it is too soon to promise strategies capable of producing an absolute differentiation. Definitive, empirically validated procedures for distinguishing genuine and deceptive pain report are not available and current approaches to the detection of deception remain to some degree intuitive. Fortunately, recent research provides evidence that (a) genuine presentations of pain differ from deceptive presentations, (b) informed and careful observers, clinicians as well as others, can discriminate genuine and deceptive presentations, and (c) empirically informed assessment approaches can be developed.

There are numerous incentives for duplicitous pain reports. The person may fake or exaggerate a display of pain to enhance the likelihood of desired outcomes, including financial payoffs, in the form of compensation payments, litigation awards, or long-term disability income, access to controlled drugs for illicit use, or other less tangible payoffs, including manipulation of others and avoidance of work, domestic, or social responsibilities. Alternatively, pain displays may be suppressed to avoid adverse consequences of others recognizing pain, including imposing the illness role on the individual, the prescription of feared medications, delivery of analgesics via needles, or deprivation of work.

Concerns about the prospects of deception and malingering of chronic pain and other medical and psychological conditions are commonplace

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