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Is there any way to tell if someone with back pain is exaggerating their symptoms? Sometimes I wonder about some of my employees who are out on sick leave for back pain.

Scientists are a long way from fully understanding back pain. What causes pain, what leads to chronic pain, and how to predict who will become disabled are still unknowns.

There may be a fine line between physical and emotional response to pain. More and more studies are finding a behavioral component to low back pain. Attitudes and actions in response to pain can lead to what's called fear-avoidance behavior or FAB.

This means if a person has back pain that hurts with certain movements, they will avoid that motion and even avoid other movements as well. Pretty soon they avoid activity because "it might hurt." It can be a downward spiral from there with increased inactivity causing stiffness and more pain. More pain leads to less movement and so on.

Some people certainly do exaggerate or magnify the symptoms. There are some tests that can help sort out behavior from physical symptoms. For example the Oswestry low back pain disability questionnaire is a measure of physical disability that can help put patients into groups. The groups include patients with no disability, mild disability, moderate or severe disability, and bed-ridden or exaggerating the symptoms.

There are also separate tests for symptom magnification. Tests of this type are performed by a medical doctor or other trained/certified health care professional. Without a formal test of this type there isn't a simple way to prove an employee is exaggerating.

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