Detecting Malingered Pain-Related Disability: Classification Accuracy of the Portland Digit Recognition Test

Abstract

This study used criterion groups validation to determine the classification accuracy of the Portland Digit Recognition Test (PDRT) at a range of cutting scores in chronic pain patients undergoing psychological evaluation (n = 318), college student simulators (n = 29), and patients with brain damage (n = 120). PDRT scores decreased and failure rates increased as a function of greater independent evidence of intentional underperformance. There were no differences between patients classified as malingering and college student simulators. The PDRT detected from 33% to nearly 60% of malingering chronic pain patients, depending on the cutoff used. False positive error rates ranged from 3% to 6%. Scores higher than the original cutoffs may be interpreted as indicating negative response bias in patients with pain, increasing the usefulness and facilitating the clinical application of the PDRT in the detection of malingering in pain.

Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

“…Several methods to try to help the clinician in detecting patients who feign something have been developed, although they are not particularly reliable. 8,12,42,67,104 The presence of this behavior in chronic pain patients is highly variable, ranging from 1.2% and 36% 3,85 ; however, other authors believe it is very low. 76 Waddell 129 considers that the incidence of malingering in low back pain is low, and is frequently mistaken with behaviors associated with pain.…”

Personal injury and other tort matters.

“…In evaluations that were conducted for Social Security disability, Chafetz (2008) reported a probable malingering rate of between 46% and 60%. Among a group of 318 patients with chronic pain who were undergoing a psychological evaluation, 35% were classified as exhibiting evidence of probable or definite malingered pain-related disability (Greve, Bianchini, Etherton, Ord, & Curtis, 2009) Much of the research on malingering detection has been conducted in the field of clinical neuropsychology, where a number of measures have been developed specifically for the assessment of feigned cognitive disorders (Boone, 2007;Larrabee, 2007) in multiple conditions, but particularly in mild TBI (Carone & Bush, 2013), although many of these procedures have also been studied in, and applied to, patients with chronic pain. These types of measures are known collectively as performance validity tests and may stand alone (e.g., developed and administered solely for the purpose of evaluating effort or malingering) or be embedded (i.e., included in a standardized neuropsychological test for which empirically derived cutoffs have been established to identify failure based on inadequate effort or malingering rather than genuine brain dysfunction).…”

Comparison of Pain, Functioning, Coping, and Psychological Distress in Patients with Chronic Low Back Pain Evaluated for Spinal Cord Stimulator Implant or Behavioral Pain Management

“…Alternatively, patients may exaggerate psychological disturbance as a cry for help or in situations when compensation or disability benefits are pending and the patient perceives that showing greater levels of psychological distress improves their chances of receiving compensation or disability benefits, or avoiding some unwanted responsibility, such as return to work or financial obligations [17]. Detecting these response biases, especially with face valid, self‐report measures has been difficult, although some use of symptom validity tests and validity scales have been shown to improve assessment accuracy in patients with pain and possible malingering [18,19]. No previous reports could be found examining whether there may be differences in pain, disability, and psychological functioning between patients referred for pain coping and behavioral treatment compared with those referred for a different reason, such as surgery or SCS.…”