Neuropathic Pain Syndrome Displayed by Malingerers

The Oregon Nerve Center, Good Samaritan Medical Center, 1040 NW 22nd Ave., Suite 600, Portland, OR 97210, USA.
The Journal of Neuropsychiatry and Clinical Neurosciences (Impact Factor: 2.82). 07/2010; 22(3):278-86. DOI: 10.1176/appi.neuropsych.22.3.278
Source: PubMed


Among 237 patients communicating chronic pain, associated with sensory-motor and "autonomic" displays, qualifying taxonomically for neuropathic pain, there were 16 shown through surveillance to be malingerers. When analyzed through neurological methods, their profile was characteristically atypical. There were no objective equivalents of peripheral or central processes impairing nerve impulse transmission. In absence of medical explanation, all 16 had been adjudicated, by default, the label complex regional pain syndrome (CRPS). The authors emphasize that CRPS patients may not only harbor unrecognized pathology ("lesion") of the nervous system (CRPS II), hypothetical central neuronal "dysfunction" (CRPS I), or conversion disorder, but may display a recognizable simulated illness without neuropsychiatric pathology.

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    • "Besides, the enhanced autonomic sympathetic activity was found facilitating nociceptive fibers to develop CRPS, but no direct evidence of activation of nociceptors related to sympathetic discharge was found [4]. Therefore, central nerve system (CNS) was concentrated on for its involvement in the pathogenesis of CRPS, especially when nerve injury existed [2,5]. In general, pain signal produced from the distal area due to various reasons needs to be transmitted along afferent fibers to dorsal root ganglia (DRG), the first relay station for pain signaling into the CNS. "
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    ABSTRACT: Abstract DRG is of importance in relaying painful stimulation to the higher pain centers and therefore could be a crucial target for early intervention aimed at suppressing primary afferent stimulation. Complex regional pain syndrome (CRPS) is a common pain condition with an unknown etiology. Recently added new information enriches our understanding of CRPS pathophysiology. Researches on genetics, biogenic amines, neurotransmitters, and mechanisms of pain modulation, central sensitization, and autonomic functions in CRPS revealed various abnormalities indicating that multiple factors and mechanisms are involved in the pathogenesis of CRPS. Epigenetics refers to mitotically and meiotically heritable changes in gene expression that do not affect the DNA sequence. As epigenetic modifications potentially play an important role in inflammatory cytokine metabolism, neurotransmitter responsiveness, and analgesic sensitivity, they are likely key factors in the development of chronic pain. In this dyad review series, we systematically examine the nerve injury-related changes in the neurological system and their contribution to CRPS. In this part, we first reviewed and summarized the role of neural sensitization in DRG neurons in performing function in the context of pain processing. Particular emphasis is placed on the cellular and molecular changes after nerve injury as well as different models of inflammatory and neuropathic pain. These were considered as the potential molecular bases that underlie nerve injury-associated pathogenesis of CRPS.
    Medical science monitor: international medical journal of experimental and clinical research 06/2014; 20:1067-77. DOI:10.12659/MSM.890702 · 1.43 Impact Factor
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    • "Personal injury insurers require a means to assess the physical and psychological status of their insured, as occurrences of unconscious symptom exaggeration (Dersh, Polatin, Leeman and Gatchel, 2004; Howard, Kishino, Johnston, Worzer and Gatchel, 2010), frank malingering (Greve, Ord, Bianchini and Curtis, 2007; Ochoa and Verdugo, 2010), and over-provision of services (Eisendrath, Rand and Feldman, 1996; Green 2011) exist in personal injury cases. Without independent medical examinations (IMEs), insurers' costs would escalate to a level that would potentially make the provision of coverage unrealistic. "
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    ABSTRACT: This article was originally published with errors that were introduced during the editing process. The corrected version of this article appears below. Abstract Independent medical examinations (IMEs) theoretically construe a means of “independently” assessing a claimant’s physical and psychological status, as well as to determine whether treatment that has been and will potentially be provided is reasonable and necessary. IMEs may be undertaken both for the plaintiff and defense or related adversaries. In the present case, we focus on IMEs that are requested by insurers. One can query the degree to which IMEs are actually “independent.” It has been posited that one of the ways in which claims managers contribute to potential bias against claimants is through a process of selectively providing examiners with medical records, which has been described as “cherry-picking.” Despite the existence of rules and laws that are designed to prevent cherry-picking, the practice still occurs. This analysis discusses the legal as well as ethical implications of cherry-picking and its potential to cause or exacerbate psychological injury that a claimant may experience. The authors propose that psychologists as well as attorneys can advocate for their vulnerable patients/clients in cases of cherry-picking. A recent case study from the clinical practice of the first author in which he so acted is provided. We conclude with a discussion of the ethical implications of the psychologist’s intervention.
    Psychological Injury and Law 06/2014; 7(2):191-196. DOI:10.1007/s12207-014-9194-y
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    ABSTRACT: The term factitious or induced illness (FII) has replaced Munchausen's syndrome by proxy, originally described by Meadow in 1977. We review evidence for the existence of this clinical problem, which is a form of child abuse. We described the epidemiology of FII and the methods of assessment of the perpetrators, and outline the psychological and demographic characteristics of these individuals. Three quarters of these (mostly women) have factitious or somatoform disorders, 90% or more severe personality disorders (particularly cluster B), and half report histories of repeated self-harm. One particular characteristic noted in over half the women with FII is the tendency to pathological lying (pseudologia fantastica), which in some can be traced to adolescence. There is an important relation between factitious illness in an adult and factitious or induced illness in a child, and the detection of one should provoke a search for the other. Families are selected for intervention where a psychiatric formulation is apparent and a treatment plan can be applied to this. Factors that influence selection include the potential for working in partnership, where there is some degree of parental acknowledgement of problems, and where better prognostic factors exist. Total denial of maltreatment or any problems means that intervention is not feasible, except in the mildest of cases. If treatment aimed at reunification is embarked upon, a clear treatment plan with explicit criteria for success, shared with all professionals is necessary. Effective management includes containment of the fabricator's long term tendency to somatize or deceive, harnessing the strength of the non-abusive carer or family members, and management of any parenting breakdown that has accompanied FII behaviour. Long-term follow up by primary health, paediatric and child and family psychiatric teams will be necessary to maintain the child's progress and prevent future relapse, or a return to somatization by the abuser.
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