Treating individuals with chronic illness and disability requires attention to physical, psychological, and social factors. These unique challenges are optimally addressed by utilizing a biopsychosocial approach, while considering the potential array of both gains and losses that chronic pain patients experience. The benefits a patient receives from remaining ill are often referred to as secondary gain. In medicolegal settings, a common example of a secondary gain issue is the effort to obtain financial compensation. While secondary gain can be one factor that contributes to perpetuating illness and disability, there are often more powerful losses that lead to such perpetuation. The losses associated with pain and disability are not frequently discussed. The overall purpose of this paper is to identify primary, secondary, and tertiary loss issues in chronic pain patients, and address issues related to how these factors are important within a medicolegal/forensic context.
The term malingering has a negative connotation, in that it is considered to intentionally project exaggerated physical and/or psychosocial symptoms for the purpose of gaining some external rewards/secondary gain. The present article will review a number of misconceptions about malingering, as well as the inherent problem in objectively measuring this construct. It will be suggested that a more comprehensive biopsychosocial approach should be used to evaluate potential barriers to recovery, as well as suboptimal performance that may delay, or prevent, recovery over an expected time period for musculoskeletal pain disorders. Such an approach will eliminate the common misuse and misdiagnosis of the construct of malingering.
This study aimed to demonstrate the relevance of the Patient-Reported Outcomes Measurement Information System (PROMIS) measures to the assessment of chronic low back pain. A literature search was conducted to find all relevant articles regarding the PROMIS domains of pain impact, behavior, interference, quality, and intensity, as well as the other PROMIS domains of sleep disturbance, fatigue, satisfaction with social roles, anxiety, depression, and physical function. Findings were compiled. Although few measures assessed low back pain specifically, all were found reliable and valid, and useful for a wide variety of other populations. The PROMIS has several advantages over other "legacy" measures, including generalizability, comparability, ease of access and use, having a wide range of methodologies to utilize in assessment, and free availability to the public. Having the PROMIS available at no additional cost will help further research by making it more accessible.
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