ABSTRACT
Providing medical care for individuals with chronic back pain for nearly 40 years has taught an important lesson, "be humble''. Compensation considerations may also influence a patient to demonstrate findings to bolster and insure continued financial and social benefits from a demonstrated disability. A patient may intentionally or unintentionally affect findings on history taking and examination which may mask malingering. A clinician should consider that any patient could be a malingerer. However, knowing typical clinical patterns of symptomatology, physical examination findings, and diagnostic testing results allows for the accurate diagnosis of clinical conditions including lumbar radiculopathy, fibromyalgia, complex regional pain syndrome, and spinal stenosis. Identifying malingerers begins with a thorough and precise clinical history. Diagnostic testing consistent with a patient's history, examination, and the clinical impression of the evaluating physician should be enhanced by radiological and electrodiagnostic testing. The patient admitted to making progress in therapy with reduced back pain and overall improvement in his physical condition.
