Addressing Suspicions of Malingering
Many times situations arise in cases that create a suspicion of symptom magnification or malingering. When this issue is present, there are concerns that the claimant may be exaggerating pain behaviors for financial incentive or to avoid returning to work. Some of the identified risk factors for malingering include ongoing litigation, significant discrepancy between subjective disability and objective findings, and lack of cooperation with the evaluation and with treatment. Unfortunately, confirmation of malingering is difficult for physicians.
1. Tenderness: Deep tenderness over a wide area or light pinching causing pain is a positive sign. Generally, physical back pain does not make the skin tender to light touch.
2. Stimulation: Downward pressure on the head that results in lower back pain or rotation of the shoulders and pelvis in unison resulting in pain is a positive sign.
3. Distraction: Straightening the leg with the hip flexed 90 degrees that results in pain is a positive sign.
4. Regional: Weakness in multiple muscles not enervated by the same root sensation is a positive sign.
5. Overreaction: An excessive show of emotion (i.e. a disproportionate grimace, tremor, bracing, guarding or exaggerated verbalizations) is a positive sign.
By: Kawania James, Esq.
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