Psychological testing and evaluation are extremely important in interventional pain management. They are even more important when proper history and physical examination as well as direct and indirect radiologic, laboratory, and diagnostic studies or even diagnostic blocks do not help to make a proper diagnosis and the patient has been shown not to have any anatomic or physiologic basis for his persistent pain as well as shown to exhibit other signs of other pain behavior. A number of theories have been found to be of benefit in the evaluation of the patient with low back pain. Depression, factitious disorder, malingering, functional test of impairment and Pain Patient Profile (P-3) have all been found to be of benefit in the evaluation of the patient with low back pain in this setting. These tests are not used in isolation and are taken in context with other workup, treatment, evaluation, and physical findings, which may be include Waddell sign, which may have been performed in this patient in order to reach a diagnosis in this setting but may have been performed in any patient in order to reach a diagnosis in that setting.

History taking needs to be detailed and a minimum routine questionnaire during the initial visit (history and physical) helps to open communication and may lead to more questions thereby providing information to improve the pretest probability or lead to a low index of suspicion. A good psychological history taking often will produce a high index of suspicion in a patient with drug abuse, diversion, addiction, tolerance, and dependence. An initial psychological and family history is usually included in the patient’s initial evaluation in an interventional pain management clinic.

In some highly suspicious circumstances, diversion or abuse can be documented quantitatively by combining urine drug screen (UDS) and blood screen with serum levels done randomly and compared with a control that was taken two to four hours after the patient took the medication.