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Strategies for assessing pain & pain exaggeration: controlled studies

  [ 24 votes ]   [ Discuss This Article ]
By Smythe HA, Gladman A, Mader R, Peloso P, Abu-Shakra M • • August 10, 1997

OBJECTIVE: To compare structured with intuitive methods of detecting
exaggerated pain, in 2 randomized studies, with masked
observers, and to compare properties of measures of relative
tenderness, as surrogates for measures of pain.

METHODS: Pairs of experienced rheumatologists assessed tenderness
and behavior in subjects who were either giving honest responses
(Not Acting) or exaggerating their tenderness while hiding the
deception (Acting). In Study 1 (20 subjects) the assessments
of behavior were descriptive only; for Study 2 (25 subjects) a
prestructured format was developed. The challenge to the
examiners was to detect Acting. The challenge to the analyst
was to develop, from the recorded data, an algorithm that
described or bettered the examiners' performance.

RESULTS: By exaggerating, nontender patients could meet formal
ACR criteria for fibromyalgia. The addition of a prestructured
pain behavior assessment in Study 2 was associated with
improvement in the observers' ability to detect Acting, with
improvement of sensitivity from 60 to 90% (p = 0.0003, Study 2
compared with Study 1). False positive diagnoses of Acting by
the observers were uniformly uncommon, with specificity of 85
and 86% in the 2 studies.

CONCLUSION: Formal numerical techniques are required and
feasible for separately assessing the structural and psychogenic
components of chronic pain.

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