Dr. Joe Etherton: When chronic pain becomes malingering
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Dr. Joe Etherton
Dr. Joe Etherton develops methods for detecting malingering, instances when people exaggerate chronic pain in order to get large Workers Compensation awards or win personal injury lawsuits.
“In cases involving financial incentive, as many as 35 percent of chronic pain sufferers will exaggerate their pain, complaining of symptoms for several years after an injury, even though doctors can’t find enough wrong to explain the pain,” said Etherton, Associate Professor of Psychology at Texas State.
“We’ve found that people are a lot less likely to malinger if they’re not pursuing financial gain,” he continued, adding that the incidence of malingering has also been shown to rise in proportion to the increase in incentive. For example, federal law provides that oil-rig workers injured offshore can receive medical and wage compensation substantially higher than that for workers injured on land, because they fall under a separate jurisdiction. Correspondingly, the percentage of detected malingering in offshore injury cases has also been shown to be significantly higher.
Etherton is one of a handful of researchers in the country who study malingering. He began studying it as a faculty member at Loyola University in New Orleans, where he worked with neuropsychologists who evaluated patients with traumatic brain injury and chronic pain from injuries.
“Some of the patients complaining of pain from carpal tunnel syndrome or back injury, for example, just weren’t getting better after a number of years. Coincidentally, most of these patients were also pursuing Workers Comp,” Etherton said.
Etherton and his colleagues have developed several tests for detecting and validating symptoms of malingering.
“On one test, for example, people score highly if they’re faking. A score of 29 or higher usually indicates a deliberate attempt to look impaired,” Etherton said. After comparing a person’s test scores and psychological evaluation, he can testify as an expert witness in Workers Comp hearings and court cases on whether someone is likely to be malingering.
“The good news,” Etherton said, “is that, if 25 percent of pain patients with a financial incentive are faking their pain, then 75 percent of patients with financial incentive aren’t faking. Currently, we bias the tests’ outcome in the patient’s favor so that we don’t make a mistake and punish someone who isn’t faking. Meanwhile, we continue to fine-tune the tests so that they’ll eventually be bias- and error-free. We’re not there yet.”