Objective evidence of pain and suffering is difficult to validate. While there are many protocols to assess the type and magnitude of pain, there is no assurance that the results are trustworthy. This is because professionals have much difficulty in assessing malingering. However, we are beginning to obtain some clues as to how to at least screen for the possibility of malingering. In a recent study by McGuire and Shores (2001) in the Journal of Clinical Psychology, they compared a pain patient population with a group of simulators or Afakers@ who were students. Their measurement was the Pain Patient Profile (P3) designed specifically for the pain patient population.

The most salient psychological feature of the pain patient is depression and the most accurate predictor of pain patient versus simulator was elevation of the Depression score. It yielded a correct classification rate of 81%. The validity (V) scale was not useful. In many cases, V scale questions are so Aobvious@ that a person of average intelligence knows better than to give an untruthful answer. In the final analysis, exaggeration of symptoms rather than presence or absence of symptoms remains the most useful clue to the detection of malingering.

Even if you are certain of your client’s truthfulness, you face another obstacle in the effective representation of your pain patient. The public tends to have an aversion to someone who is either suffering and/or complaining. They want to avoid such people because they are afraid it might happen to them. It is as if they are protecting themselves from this fate. The public also minimizes reported suffering for the same reasons. Thus, the pain patient must not only struggle with his/her condition on a daily basis, but must also endure the isolation and prejudice directed towards him/herself. You will have to overcome your own aversion as well as educate the public. This is not an easy task.