Guest guest Posted June 5, 2007 Report Share Posted June 5, 2007 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 5, 2007 Report Share Posted June 5, 2007 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 5, 2007 Report Share Posted June 5, 2007 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2007 Report Share Posted June 6, 2007 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 9, 2007 Report Share Posted June 9, 2007 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. Moody friends. Drama queens. Your life? Nope! - their life, your story. Play Sims Stories at Games. Quote Link to comment Share on other sites More sharing options...
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