An Instrument to Detect Pain Feigning: The Pain Feigning Detection Test (PFDT)

Abstract

A pain feigning inventory does not yet exist in the field, despite the need for such an instrument in tort, disability, compensation, and other types of forensic and mental health evaluations. The chapter proposes an instrument on the detection of pain feigning that consists of 67 items. Its primary innovation is to compare patient’s self-report of ongoing pain experience with baseline estimates of physical injury or condition and expected associated pain. Once fully developed, the instrument should provide data toward determining respondents’ validity of presentation about their pain experience and, in particular, about the possible presence of malingering and related response biases. The scores deriving from the instrument need to be interpreted as part of a comprehensive assessment with a full reliable data set gathered. The instrument should help evaluators in undertaking comprehensive, scientifically-informed, impartial assessments that meet professional and court requirements. It is called the Pain Feigning Detection Test (PFDT).

Many thanks to Robert Erard, David Berry, Brain Levitt, and Andy Kane for comments. Until it is developed psychometrically, the proposed instrument is meant for research purposes and not clinical or forensic purposes. However, practitioners could use portions of it in interview format

Appendix

The Pain Feigning Detection Test (PFDT)

Instructions

This pain survey should take 10–15 min to complete. The major part of the questionnaire asks how bad is your pain and how you are dealing with it (45 questions on a scale from 0 to 6, with the points defined in the questionnaire). But before we begin this major part of the questionnaire, there are a few questions at the beginning about what you and your primary care professionals (e.g., your family doctor) believe about your physical injuries/condition and the pain levels expected from them. If a significant other such as a spouse has an idea about this, too, that would help. At the end of the questionnaire, there is space for some personal comments on your pain experience.

It is important to note that information used to answer the baseline questions might change. In this regard, the primary care professional might be sent new medical information after the instrument is filled in that would change the baseline estimates. For example, an MRI might reveal either a herniated disc or its absence after initial screening had indicated the opposite. In these cases, the instrument results would have to be verified and perhaps annulled. The instrument can be rescored using the new information. Therefore, the patient and/or other people filling in the questionnaire or providing information for it should supply any new relevant information to the assessor and any other person who had received the results related to the questionnaire.

NB. This instrument is not to be used for clinical or forensic purposes until its validity and reliability have been established by research leading to publication in peer-reviewed journals.

I. Baseline Questions

A. Patient

• 1. On average, my doctors or primary medical professionals have informed me that my physical injuries or physical conditions that are related to the pain that I feel are …..

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

• 2. On average, my doctors or primary medical professionals have informed me that the pain I feel because of my physical injuries or physical conditions should be …

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

B. Primary Medical Professionals

(indicate type of professional _____________________________)

• 1. On average, doctors or primary medical professionals have informed this patient that the physical injuries or physical conditions related to the pain being felt are …..

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

• 2. On average, doctors or primary medical professionals have informed this patient that the pain being felt because of the physical injuries or physical conditions should be …

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

C. Significant Other (if available)

(indicate relationship to patient _____________________________)

• 1. On average, doctors and primary medical professionals have informed this patient that the physical injuries or physical conditions related to the pain being felt are …..

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

• 2. On average, doctors and primary medical professionals have informed this patient that the pain being felt because of the physical injuries or physical conditions should be …

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

II. Major Pain Areas and Pain Intensity

A. Body Pain (includes all areas from the neck down; excludes the head, jaw, and facial regions)

Please list the location of your …	Please indicate how bad it feels
1. worst pain _______________________	6. _____ out of 10
2. next pain _______________________	7. _____ out of 10
3. next pain _______________________	8. _____ out of 10
4. next pain _______________________	9. _____ out of 10
5. next pain _______________________	10. _____ out of 10

To answer, use a subjective pain intensity scale, where 0 is no pain and 10 is the worst pain imaginable and it feels you have to go to the hospital.

B. Head Pain (includes headaches, jaw and face pain)

Please list the location of your …

Please list the location of your …	Please indicate how bad it feels
1. worst pain _______________________	6. _____ out of 10
2. next pain _______________________	7. _____ out of 10
3. next pain _______________________	8. _____ out of 10
4. next pain _______________________	9. _____ out of 10
5. next pain _______________________	10. _____ out of 10

To answer, use a subjective pain intensity scale, where 0 is no pain and 10 is the worst pain imaginable and it feels you have to go to the hospital.

III. Pain Experience Report

A. Questions

• 1. The pain that I experience is, for me, ….

  nothing	mild/minor		moderate		severe	not sure
  0	1	2	3	4	5	x

• 2. It has lasted this way for ________ months.

  <1

  1–2

  3–6

  7–12

  12–24

  24 +

  not sure

• 3. The pain mostly is in _____ place(s)?

  0 places

  1

  2

  3

  4

  5+

  not sure

• 4. The pain is also in areas unrelated to my injuries or condition.

  nothing	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 5. The pain varies as the day goes on.

  nothing	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 6. Some days during the week, I have much less or even no pain.

  0 day/week

  1

  2

  3

  4

  5+

  not sure

• 7. Some days during the week, I get professional treatment such as physiotherapy for my pain.

  0

  1

  2

  3

  4

  5+

  not sure

• 8. Some days during the week, I exercise, move, or stretch for my pain.

  0

  1

  2

  3

  4

  5+

  not sure

• 9. I need the following medications.

  none	over the counter regular		prescribed (e.g., Tylenol 3)		narcotics
  0	1	2	3	4	5

• 10. I continue with my normal life despite the pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 11. I cope with the pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 12. The pain controls my life.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 13. I feel that even when the pain is less, this is the worst thing that could have happened to me.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 14. Stress that happens to me makes my pain worse.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 15. I keep worrying about the pain and can’t stop.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 16. I keep telling myself I know it will get worse.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 17. It causes me great distress/or depression.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 18. I get angry about it (and the cause).

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 19. I fear doing things because of the pain/I fear the pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 20. Other people understand my pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 21. Other people do enough for me when I’m in pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 22. My doctors and primary medical professionals understand my pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 23. My doctors and primary medical professionals do enough for my pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 24. My insurance company(ies) (and their doctors and primary medical professionals) understand my pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 25. My insurance company(ies) (and their doctors and primary medical professionals) do enough for my pain.

  none	a bit		sometimes	a lot	always	not sure
  0	1	2	3	4	5

• 26. My body pain gets so bad, it spreads to my fingernails until I cut them.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 27. My head pain gets so bad, it spreads to my fingernails until I cut them.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 28. My body pain gets so bad, it spreads to the tip of my hair until I cut it.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 29. My head pain gets so bad, it spreads to the tip of my hair until I cut it.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 30. My body pain gets so bad, it freezes my feet for hours.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 31. My head pain gets so bad, it freezes my feet for hours.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 32. My body pain gets so bad, it freezes me in the same position for hours.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 33. My head pain gets so bad, it freezes me in the same position for hours.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 34. My body pain gets so bad, my earlobes turn green.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 35. My head pain gets so bad, my earlobes turn green.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 36. My body pain gets so bad, I have to play my favorite games for hours.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 37. My head pain gets so bad, I have to play my favorite games for hours.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 38. My body pain gets so bad, I use pain reduction techniques such as banging my head too hard on the wall.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 39. My head pain gets so bad, I use pain reduction techniques such as banging my head too hard on the wall.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 40. If my pain ever goes away, I’ll go back to my day life like it was before it began.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 41. I was happy with my home life before the pain began.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 42. I was happy with what I did in the day (work, care for children, study, or whatever you did) before the pain began.

  none	a bit		sometimes		always	not sure
  0	1	2	3	4	5

• 43. I had stresses in my life before this pain began that was ____________ than the stresses of this body pain.

  Absent, not even a bit more less	much		same	little more	much more	N/A
  0	1	2	3	4	5

• 44. I had psychological problems or disorders before my pain began that were ____________ than the ones of this pain.

  Absent, not even a bit more less	much		same	little more	much more	N/A
  0	1	2	3	4	5

• 45. I had other pains in my life before this pain began that were ____________ than the ones of this pain.

  Absent, not even a bit more less	much		same	little more	much more	N/A
  0	1	2	3	4	5

B. Comments

• 1. Your Comments to Help Understand Your Pain (1). In particular, let us know in your own words how bad is your pain and how it has changed your life.

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

• 2. Also, it is important to know if the pain experience is making you suicidal or making you want to harm someone.

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

• 3. Assessor’s Comments of Patient Presentation while Filling in the Questionnaire, if available

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________

  _______________________________________________________________