RE: [OregonDCs] Marxer's test

[Guest guest]

Lyndon,

Marxer (who by the way was an orthopedic

surgeon from Portland— Burke has been researching this) is a “simulation”

test, in the parlance of Waddle’s non-organic pain signs…that is it

is a test that isn’t supposed to do anything provocative. If the

patient reacts painfully, it may be a sign of non-organic pain behavior,

not necessarily “malingering.” Malingering implies

willful deceit. Non-organic pain is that which is not readily related to

known pathology (i.e. enhanced by psychosocial factors).

Anyway, Marxer is performed patient prone,

one leg flexed at the knee to 90 degrees with plantar and dorsiflexion of the

ankle. Provoking low back or lower extremity pain is suggestive of

non-organic pain behavior. Note that the knee flexion itself may provoke

femoral nerve stretch and also some measure of lumbosacral extension (a la

Nachlas and Hibbs) so some care is needed to differentiate “real”

pain from non-organic pain behavior.

Note also that a single non-organic pain

sign is not correlated with psychological distress. Waddle considered 3

or more of the 5 non-organic signs to be related to elevation of the hysteria

and hysteresis scales on the MMPI, which in turn has been correlated with heightened

pain reactions. Some consider the non-organic signs to be a good

screening test (WSCC protocols for example). Others have challenged Waddle’s

signs more recently as being inaccurate. In my experience, if the whole

picture looks fishy, non-organic signs help complete the diagnosis. By

itself in isolation, Marxer doesn’t mean much.

A. Simpson, DC

Vice President, Medical Director

Complementary Healthcare Plans

6600 SW 105th Avenue, Suite 115

Beaverton, OR 97008

503-619-2041

csimpson@...

From:

[mailto: ] On Behalf Of Lyndon McGill

Sent: Tuesday, June 05, 2007 11:08

AM

Oregon

DCs

Subject: [OregonDCs] Marxer's test

Docs:

Can anyone remind me how to perform Marxer's test for malingering?

Lyndon McGill, D.C.

Salem, Oregon

[Guest guest]

Also note that Waddell now questions the validity of his own tests... Matt Terreri, DC"Chuck Simpson, DC" <csimpson@...> wrote: Lyndon, Marxer (who by the way was an orthopedic surgeon from Portland— Burke has been researching this) is a “simulation” test, in the parlance of Waddle’s non-organic pain signs…that is it is a test that isn’t supposed to do anything provocative. If the patient reacts painfully, it may be a sign of non-organic pain behavior, not necessarily “malingering.” Malingering implies willful deceit. Non-organic pain is that which is not readily related to known pathology (i.e. enhanced by psychosocial factors). Anyway, Marxer is performed patient prone, one leg flexed at the knee to 90 degrees with plantar and dorsiflexion of the ankle. Provoking low back or lower extremity pain is suggestive of non-organic pain behavior. Note that the knee flexion itself may provoke femoral nerve stretch and also some measure of lumbosacral extension (a la Nachlas and Hibbs) so some care is needed to differentiate “real” pain from non-organic pain behavior. Note also that a single non-organic pain sign is not correlated with psychological distress. Waddle considered 3 or more of the 5 non-organic signs to be related to

elevation of the hysteria and hysteresis scales on the MMPI, which in turn has been correlated with heightened pain reactions. Some consider the non-organic signs to be a good screening test (WSCC protocols for example). Others have challenged Waddle’s signs more recently as being inaccurate. In my experience, if the whole picture looks fishy, non-organic signs help complete the diagnosis. By itself in isolation, Marxer doesn’t mean much. A. Simpson, DC Vice President, Medical Director Complementary Healthcare Plans 6600 SW 105th Avenue, Suite 115 Beaverton, OR 97008 503-619-2041 csimpsonchpplans (DOT) us From: [mailto: ] On Behalf Of Lyndon McGillSent: Tuesday, June 05, 2007 11:08 AMOregon DCsSubject: [OregonDCs] Marxer's test Docs:Can anyone remind me how to perform Marxer's test for malingering?Lyndon McGill, D.C.Salem, Oregon

Sick sense of humor? Visit TV's Comedy with an Edge to see what's on, when.

[Guest guest]

Waddell's original article and tests circa 1981 Spine were to determine whom was a good patient for surgey as in gaining a positive outcome. These of course were patients who had hard clinical symptoms, signs, and imaging that ear marked them for surgery as I recall....

Vern SAboe

[OregonDCs] Marxer's test

Docs:Can anyone remind me how to perform Marxer's test for malingering?Lyndon McGill, D.C.Salem, Oregon

Sick sense of humor? Visit TV's Comedy with an Edge to see what's on, when.

[Guest guest]

Vern et al,

Spine has been full of articles on this…see

these 33 hits

http://www.spinejournal.com/pt/re/spine/searchresults.htm;jsessionid=GmLJ6XczrRdcs9QW1Cfd3K3TllpHY8GR5zjGlDQ6q0wv82sXHjWn!-1804036389!-949856145!8091!-1? & index=1 & results=1 & searchid=3

A. Simpson, DC

Vice President, Medical Director

Complementary Healthcare Plans

6600 SW 105th Avenue, Suite 115

Beaverton, OR 97008

503-619-2041

csimpson@...

From:

[mailto: ] On Behalf Of Vern Saboe

Sent: Tuesday, June 05, 2007 4:02

PM

;

Matt Terreri

Subject: Re: [OregonDCs] Marxer's

test

Waddell's original article and tests circa 1981 Spine

were to determine whom was a good patient for surgey as in gaining a

positive outcome. These of course were patients who had hard clinical

symptoms, signs, and imaging that ear marked them for surgery as I recall....

Vern SAboe

[OregonDCs] Marxer's test

Docs:

Can anyone remind me how to perform Marxer's test for malingering?

Lyndon McGill,

D.C.

Salem, Oregon

Sick sense of humor? Visit TV's Comedy

with an Edge to see what's on, when.

[Guest guest]

I'll try to dig up the citations... Matt Terreri, DC"Chuck Simpson, DC" <CSimpson@...> wrote: Interesting…tell me more. Do you have a citation? A. Simpson, DC Vice President, Medical Director Complementary Healthcare Plans 6600 SW 105th Avenue, Suite 115 Beaverton, OR 97008 503-619-2041 csimpson@... From: [mailto: ] On Behalf Of Matt TerreriSent: Tuesday, June 05, 2007 3:09 PM Subject: RE: [OregonDCs] Marxer's test Also note that Waddell now questions the validity of his own tests... Matt Terreri, DC"Chuck Simpson, DC" <csimpsonchpplans (DOT) us> wrote: Lyndon, Marxer (who by the way was an orthopedic surgeon

from Portland— Burke has been researching this) is a “simulation” test, in the parlance of Waddle’s non-organic pain signs…that is it is a test that isn’t supposed to do anything provocative. If the patient reacts painfully, it may be a sign of non-organic pain behavior, not necessarily “malingering.” Malingering implies willful deceit. Non-organic pain is that which is not readily related to known pathology (i.e. enhanced by psychosocial factors). Anyway, Marxer is performed patient prone, one leg flexed at the knee to 90 degrees with plantar and dorsiflexion of the ankle. Provoking low back or lower extremity pain is suggestive of non-organic pain behavior. Note that the knee flexion itself may provoke femoral nerve stretch and also some measure

of lumbosacral extension (a la Nachlas and Hibbs) so some care is needed to differentiate “real” pain from non-organic pain behavior. Note also that a single non-organic pain sign is not correlated with psychological distress. Waddle considered 3 or more of the 5 non-organic signs to be related to elevation of the hysteria and hysteresis scales on the MMPI, which in turn has been correlated with heightened pain reactions. Some consider the non-organic signs to be a good screening test (WSCC protocols for example). Others have challenged Waddle’s signs more recently as being inaccurate. In my experience, if the whole picture looks fishy, non-organic signs help complete the diagnosis. By itself in isolation, Marxer doesn’t mean

much. A. Simpson, DC Vice President, Medical Director Complementary Healthcare Plans 6600 SW 105th Avenue, Suite 115 Beaverton, OR 97008 503-619-2041 csimpsonchpplans (DOT) us From: [mailto: ] On Behalf Of Lyndon McGillSent: Tuesday, June 05, 2007 11:08 AMOregon DCsSubject: [OregonDCs] Marxer's test Docs:Can anyone remind me how to perform Marxer's test for malingering?Lyndon McGill, D.C.Salem, Oregon Sick sense of humor? Visit TV's Comedy with an Edge to see what's on, when.

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