Does the conscious exaggeration scale detect deception within patients with chronic pain alleged to have secondary gain?

David A. Fishbain, Robert B. Cutler, Hubert L. Rosomoff, Renee Steele-Rosomoff

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objectives. The illness behavior questionnaire (IBQ) is a test battery developed by Pilowsky to detect what he has termed abnormal illness behavior, which includes malingering [4]. The IBQ has been widely utilized in patients with chronic pain (PWCP). Clayer developed a 21-item scale out of the IBQ, which he termed the conscious exaggeration (CE) scale [7]. He proposed that the CE scale could detect conscious deception, i.e., malingering. The purpose of the present study is to test the CE scale in PWCP alleged to have secondary gain and thereby at greater risk for poor pain treatment outcome. It was postulated that the CE scale should generate scores in these groups significantly different from a comparison group and should predict treatment outcome in the secondary gain groups. Design. A total of 96 PWCP completed the CE scale at admission and after completion of a 1-month pain facility treatment regimen. Other relevant pain variables, such as pain, depression, and anxiety, were measured and the data collected at admission and treatment completion. Work status was determined at 1, 3, 6, 12, 18, 24, and 30 months posttreatment. PWCP secondary gain subgroups (Workers' Compensation patients, patients in litigation, patients having a lawyer) were compared to the comparison group (no secondary gain factors) for treatment CE scale change scores. In order to control for the effects of pain, an analysis of covariance with pain level statistically removed was performed on admission and discharge CE scores utilizing the above patient subgroups. Pearson product correlations were utilized to determine the relationships between CE scores and psychological variables. Stepwise regression analyses were utilized to predict return to work with the CE scale score as a potential predictor. Setting. Pain facility. Patients. PWCP treated for 1 month in a pain facility. Results. Overall, the analyses did not support the main hypothesis. For example, CE scale scores did not predict return to work. There was a significant degree of correlation between the variables of pain, depression, anxiety, and CE scale scores. Conclusions. PWCP characterized by the alleged secondary gain variables of Workers' compensation status, litigation, and having a lawyer did not differentially respond to the CE scale versus the comparison group. The CE scale, therefore, does not appear to be a valid instrument for identifying exaggeration in PWCP.

Original languageEnglish (US)
Pages (from-to)39-46
Number of pages8
JournalPain Medicine
Issue number1
StatePublished - 2002


  • Anxiety
  • Chronic pain
  • Conscious exaggeration (CE) scale
  • Deception
  • Depression
  • Illness behavior questionnaire (IBQ)
  • Malingering
  • Secondary gain
  • Treatment outcome

ASJC Scopus subject areas

  • Clinical Neurology


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