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Biomedical subjects

D A Fishbain

Publications and source records attributed to D A Fishbain.

At least 37 records · Page 2Linked to original sources
PubMed1999

Chronic pain disability exaggeration/malingering and submaximal effort research.

OBJECTIVE: This is the first review of chronic pain (CP) malingering/disease simulation research. The purpose of this review was to determine the prevalence of malingering within CP patients (CPPs), whether evidence exists that malingering can be detected within CPPs, and to suggest some avenues of research for this topic. DESIGN: A computer and manual literature search produced 328 references related to malingering, disease simulation, dissimulation, symptom magnification syndrome, and submaximal effort. Of these, 68 related to one of these topics and to pain. The references were reviewed in detail, sorted into 12 topic areas, and placed into tabular form. These 12 topic areas addressed the following: existence of malingering within the CP setting; dissimulation, identification simulated (faked) facial expressions of pain; identification of malingering by questionnaire; identification of malingered sensory impairment; identification of malingered loss of hand grip strength; identification of submaximal effort by isometric strength testing; identification of submaximal or malingered effort by isokinetic strength testing; identification of submaximal or malingered effort by the method of coefficient of variation; self-deception; symptom magnification syndrome; and miscellaneous malingering identification studies. Each report, in each topic area, was rated for scientific quality according to guidelines developed by the Agency for Health Care, Policy and Research (AHCPR) for rating the level of evidence presented in the reviewed study. The AHCPR guidelines were then used to rate the strength and consistency of the research evidence in each topic area based on the type of evidence the reports represented. All review conclusions were based on the results of these ratings. SETTING: Any medical setting reporting on either malingering or disease simulation, or dissimulation, or submaximal effort and pain. PATIENTS: Normal volunteers, CPPs, or any group asked to produce a submaximal or malingered effort or a malingered test profile. RESULTS: The reviewed studies indicated that malingering and dissimulation do occur within the CP setting. Malingering may be present in 1.25-10.4% of CPPs. However, because of poor study quality, these prevalence percentages are not reliable. The study evidence also indicated that malingering cannot be reliably identified by facial expression testing, questionnaire, sensory testing, or clinical examination. There was no acceptable scientific information on symptom magnification syndrome. Hand grip testing using the Jamar dynamometer and other types of isometric strength testing did not reliably discriminate between a submaximal/malingering effort and a maximal/best effort. However, isokinetic strength testing appeared to have potential for discriminating between maximal and submaximal effort and between best and malingered efforts. Repetitive testing with the coefficient of variation was not a reliable method for discriminating a real/best effort from a malingered effort. CONCLUSIONS: Current data on the prevalence of malingering within CPPs is not consistent, and no conclusions can be drawn from these data. As yet, there is no reliable method for detecting malingering within CPPs, although isokinetic testing shows promise. Claims by professionals that such a determination can be made should be viewed with caution.

Chronic Disease↗
PubMed1999

The association of chronic pain and suicide.

Chronic pain patients (CPPs) are at greater risk for depression than the general population. As such, one would expect suicidal ideation, suicide attempts, and suicide completions to be commonly found within chronic pain (CP) populations. To explore these issues, 18 studies relating to the association of CP and suicide were subjected to a structured review. These studies indicated that suicide ideation, suicide attempts, and suicide completions are commonly found in CPP populations. In addition, a number of controlled studies and suicide completion rate studies indicated that CP may be a suicide risk factor. Finally, a review of known suicide risk factors from other populations indicated that CP populations commonly exhibit other suicide risk factors. Psychiatric examiners should consider CP to be a potential suicide risk factor. In addition, in all CPPs exhibiting suicidal behavior, a careful search for associated comorbid suicide risk factors should be initiated.

Chronic Disease↗
PubMed1998

Long-term transcutaneous electrical nerve stimulation (TENS) use: impact on medication utilization and physical therapy costs.

OBJECTIVE: A study was conducted to assess a variety of treatment outcomes in long-term users of transcutaneous electrical nerve stimulation (TENS) who suffer from chronic pain. Key components of the study examined the effects of long-term TENS therapy on pain-related medications and physical/occupational therapy (PT/OT) use. DESIGN: From a population of 2,(X)3 chronic pain patients (CPPs) who acquired a TENS device (Epix XL, Empi, Inc., St. Paul, MN, U.S.A.) for pain management, a randomly selected sample of 376 patients who used TENS were interviewed by telephone by an independent research firm. The survey assessed a variety of outcome variables including changes in medication use, number of pain-related medications, and use of PT/OT prior to TENS and after a minimum 6 months of TENS treatment. The data were subjected to a paired t test analysis. A cost simulation model was then applied to the medication and PT/OT data. RESULTS: The mean duration of pain, for which TENS was prescribed, was 40 +/- 60 months. As compared with the period prior to TENS use, this long-term TENS user group reported a statistically significant reduction in the following types of pain medications: opiate analgesics, tranquilizers, muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids. PT/OT use was also significantly reduced. Cost simulations of pain medications and PT/OT are presented. CONCLUSIONS: Long-term use of TENS is associated with a significant reduction in the utilization of pain medication and PT/OT. In this study population, cost simulations of medication and PT/OT indicate that with long-term TENS use, costs can be reduced up to 55% for medications and up to 69% for PT/OT. The potential for TENS associated improvement, combined with reduced medication-related complications and costs, are important points that clinicians should consider when constructing a treatment plan for chronic pain patients. Finally, cost simulation techniques provide a useful tool for assessing outcomes in pain treatment and research.

Adult↗
PubMed1997

Chronic pain-associated depression: antecedent or consequence of chronic pain? A review.

OBJECTIVE: To determine the current status for the association of chronic pain and depression and to review the evidence for whether depression is an antecedent or consequence of chronic pain (CP). DESIGN: A computer and manual literature review yielded 191 studies that related to the pain-depression association. These reports were reviewed and sorted into seven categories relating to the topic of this paper. Eighty-three studies were then selected according to inclusion criteria and subjected to a structured review. SETTING: Any medical treatment setting including pain treatment as inclusion criteria for selection of studies. PATIENTS: Any patients with any type of chronic pain. RESULTS: The reviewed studies were consistent in indicating that there is a statistical relationship between chronic pain and depression. For the relationship between pain and depression, there was greater support for the consequence and scar hypotheses than the antecedent hypothesis. CONCLUSIONS: Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution.

Brain Chemistry↗
PubMed1997

Impact of chronic pain patients' job perception variables on actual return to work.

OBJECTIVE: To examine the impact of preinjury job perceptions on chronic pain patients (CPPs) return to work after pain facility treatment. DESIGN: A total of 128 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to "intent" to return to the same type of preinjury job following pain facility treatment. These CPPs were part of a grant study for prediction of return to work, and therefore their work status was determined at 1, 3, 6, 12, 18, 24, and 30 months after treatment. The preinjury job perceptions and other demographic variables were used to predict return to work. Stepwise discriminant analysis was used to predict return to work at the 1-month and final time points utilizing the above variables. Stepwise regression analysis was used to predict mean employment status (at all time points) also using the above variables. SETTING: Multidisciplinary Pain Center. PATIENTS: Consecutive CPPs. RESULTS: For the 1-month time point, employment status was predicted by "intent," educational status, work dangerous perception complaint, job stress, job physical demands, job liking, and job role conflicts. Here, 79.49% of the CPPs were correctly classified. For the final time point, employment status was predicted by the first three predictors for the 1-month time point (in the same order) and age, job stress, and gender. Here, 74.58% of the CPPs were correctly classified. Mean employment status was predicted by "intent" and educational status. CONCLUSIONS: There is a relationship between preinjury job perceptions and actual return to work after pain facility treatment. Voiced "intent" not to return to the preinjury type of job is highly predictive of not returning to work after pain facility treatment.

Accidents, Occupational↗
PubMed1996

"Movement" in work status after pain facility treatment.

STUDY DESIGN: This was a randomized prospective follow-up study of pain facility treatment of chronic pain patients with low back pain, with return to work and work capacity as the outcome measures. OBJECTIVES: To determine if after pain facility treatment chronic pain patients "move" in and out of work and in their work capacity; to determine the patterns of "movement;" and to determine the post-pain facility treatment follow-up sampling time points that would maximize the number of chronic pain patients correctly classified according to their final work and work capacity status. SUMMARY OF BACKGROUND DATA: Past research and empiric observation have indicated that chronic pain patients may "move" after pain facility treatment in and out of work and in their job work capacity. Such "movement" can affect the results of outcome studies. METHODS: Two hundred thirty-six consecutive chronic pain patients who fit study selection criteria were followed up at 1, 3, 6, 12, 18, 24, and 30 months after pain facility treatment for determination of work and work capacity status and separated according to the pattern of movement. Stepwise discriminant analysis was used to answer the study objectives. "Movement" in and out of work for these chronic pain patients also was compared with the US general population. RESULTS: Chronic pain patients demonstrated eight work and four work capacity movement patterns. The 24- and 1-month time points predicted final work status correctly for 97.0% and 77.0% of the chronic pain patients, respectively, whereas the most significant predictor for correct work capacity status was the 24-month point. The annual percentage change in employment status for these chronic pain patients was more than in the US general population. CONCLUSIONS: Because chronic pain patients "move" in and out of employment and for work capacity status after pain facility treatment, future outcome studies using these measures will have to consider carefully the impact of "movement" on their results.

Chronic Disease↗
PubMed1996

Transcutaneous electrical nerve stimulation (TENS) treatment outcome in long-term users.

OBJECTIVE: Previous reviewers of the literature on transcutaneous electrical nerve stimulation (TENS) outcome have concluded the following: (a) there are few long-term TENS follow-up studies, and (b) fewer studies have addressed the effect of long-term TENS use on outcome variables other than pain (e.g., function). DESIGN/SETTING/PARTICIPANTS/OUTCOME MEASURES: From a population of 2,003 chronic pain patients (CPPs) who bought a TENS device for pain management, 506 patients were randomly selected and interviewed by telephone long enough after purchase to allow at least 6 months of TENS use. The interview process used a structured "skip" questionnaire designed to assess the CPPs' perceptions regarding the effectiveness of TENS for a variety of outcome variables. Of the 506 CPPs interviewed, 376 (74.3%) had used their TENS device for 6 months or longer and were defined as long-term users. The responses of this group of CPPs to the telephone questionnaire were then subjected to statistical analysis. RESULTS: Paired t-tests, correlated z-tests, SS Wilks, and chi-square tests demonstrated statistically significant change or improvement (p < 0.05) that paralleled the introduction of TENS use in the following outcome variables: less pain interference with work, home, and social activities; increased activity level and pain management; decreased use of other therapies (e.g., physical therapy, occupational therapy, chiropractic); decreased use of narcotics, tranquilizers, muscle relaxants, nonsteroidal anti-inflammatory drugs and steroids. CONCLUSIONS: The results suggest that TENS is associated with improvement on multiple outcome variables in addition to pain relief for CPPs who are long-term users. Also, for some CPPs, long-term TENS use continues to be effective.

Chronic Disease↗
PubMed1995

I. Do chronic pain patients' perceptions about their preinjury jobs determine their intent to return to the same type of job post-pain facility treatment?

OBJECTIVE: To demonstrate that chronic pain patients' (CPPs') perceptions about their preinjury jobs determine their intent to return to the same type of job post pain facility treatment. DESIGN: A total of 225 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to intent to return to the same type of preinjury job post-pain facility treatment. The CPPs were broken down into subgroups (males, females, college males, noncollege males, college females, noncollege females), and within each subgroup those not intending to return to the same type of pre-injury job were compared to those intending to return on the preinjury job perception questions. In addition for the whole group, stepwise discriminant analysis was used to predict who planned to return to the preinjury job utilizing the job perceptions questions. SETTING: Multidisciplinary Pain Center. PATIENTS: Consecutive chronic pain patients. RESULTS: For the whole group, CPPs not intending to return were more likely to complain of job excessive physical demands, job satisfaction, and job dislike. Job perception complaints that were significantly different between the intending and not intending to return groups differed between the subgroups. For example, noncollege males not intending to return were more likely to complain of excessive physical demands only versus satisfaction and liking as significant items for college males who did not intend to return. Within the discriminant analysis, the combination of job satisfaction, excessive physical demands, employee conflicts, job liking, job dangerousness, supervisory conflicts, job stress, and age classified 73.46% of the CPPs correctly as to intent to return to the same type of preinjury job. CONCLUSIONS: There appears to be a relationship between preinjury job perceptions and intent to return to the same type of job post pain treatment. However, subgroups of CPPs will differ by which job perceptions are important towards making that decision.

Accidents, Occupational↗
PubMed1995

II. Do chronic pain patients' perceptions about their preinjury jobs differ as a function of worker compensation and non-worker compensation status?

OBJECTIVES: (1) To demonstrate a relationship between intent to return to preinjury job and preinjury job perceptions about that job; and (2) to demonstrate that worker compensation chronic pain patients (WC CPPs) would be more likely than non-worker compensation chronic pain patients (NWC CPPs) not to intend to return to a preinjury type of job because of preinjury job perceptions. STUDY DESIGN: The relationship between preinjury job perceptions and intent to return to the preinjury job was investigated and compared between worker compensation (WC) and nonworker compensation (NWC) chronic pain patients (CPPs). Within the WC and NWC groups CPPs not intending to return to their preinjury type of work were compared to those CPPs intending to return on preinjury job perception. BACKGROUND DATA: Compensation status, being a WC CPPs or being a non-WC CPPs, has been claimed to be predictive or not predictive of return to work post pain treatment. These studies have, however, ignored the preinjury job stress perception variable as an area of research. METHODS: WC CPPs were age- and sex-matched to NWC CPPs and statistically compared on their responses to rating scale and yes/no questionnaires for intent to return to work and perceived preinjury job stress. In a second analysis, both the WC and NWC groups were divided according to their intent to return to work and statistically compared on their responses to these questionnaires. RESULTS: Both male and female WC CPPs were less likely than their counterparts to intend to return to their preinjury job. Both WC and NWC were found to complain of preinjury job complaints, and these complaints were found to differ between WC and NWC CPPs. An association between intent not to return to work and the perceptions of preinjury job dissatisfaction and job dislike was found for male and female WC CPPs and for male and female NWC CPPs. CONCLUSIONS: There may be a relationship between some preinjury job perceptions and intent to return to the preinjury type of work in some groups of CPPs. However, a specific relationship between WC status, intent not to return to the preinjury type of work, and preinjury job perceptions in comparison to NWC CPPs could not be demonstrated.

Accidents, Occupational↗