A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs

Pain Medicine

Volumn 4, Issue 2, 2003, Pages 141-181

  Fishbain, David A ^a,b,c   Cole, Brandly ^b,c   Cutler, R B ^a,b,c   Lewis, John ^a   Rosomoff, H L ^a,b,c   Rosomoff, R Steele ^a,b,c  

^a UNIVERSITY OF MIAMI MILLER SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF MIAMI   (United States)

^c South Shore Hospital Miami Beach   (United States)

Author keywords

Abnormal illness behavior; Chronic pain; Conversion symptoms; Disease magnification; Malingering; Nondermatomal sensory abnormalities; Nonorganic physical signs; Somatic amplification; Waddell signs

Indexed keywords

CHRONIC PAIN; CLASSIFICATION; CLINICAL FEATURE; CORRELATION ANALYSIS; DISTRESS SYNDROME; EVIDENCE BASED MEDICINE; FACTORIAL ANALYSIS; FUNCTIONAL ASSESSMENT; HEALTH CARE POLICY; HUMAN; HYSTERIA; ILLNESS BEHAVIOR; LOW BACK PAIN; MALINGERING; MEDICAL RESEARCH; METHODOLOGY; PAIN ASSESSMENT; PHYSICAL EXAMINATION; PRACTICE GUIDELINE; PREDICTION; QUALITY CONTROL; RELIABILITY; REVIEW; SCORING SYSTEM; SELF ESTEEM; SOMATIZATION; TREATMENT OUTCOME; VALIDATION PROCESS; WADDELL SIGN; COMPUTER; MEDICAL LITERATURE; MINNESOTA MULTIPHASIC PERSONALITY INVENTORY; OUTCOMES RESEARCH; PAIN; PERFORMANCE; QUALITATIVE ANALYSIS;

ACUTE DISEASE; CHRONIC DISEASE; EVIDENCE-BASED MEDICINE; FEMALE; HUMANS; MALE; MALINGERING; PAIN; PAIN MEASUREMENT; PREDICTIVE VALUE OF TESTS; SICK ROLE;

EID: 0042743771     PISSN: 15262375     EISSN: None     Source Type: Journal    
DOI: 10.1046/j.1526-4637.2003.03015.x     Document Type: Review

References (99)

1. Waddell G, McCulloch JA, Kummel E, et al. Nonorganic physical signs in low-back pain. Spine 1980;5:117-25.
2. Waddell G. Biopsychosocial analysis of low back pain. Baillieres Clin Rheumatol 1992;6:523-57.
3. Waddell G, Pilowsky I, Bond MR. Clinical assessment and interpretation of abnormal illness behaviour in low back pain. Pain 1989;39:41-53.
4. Frost HM. Diagnosing musculoskeletal disability of psychogenic origin in orthopaedic practice. Clin Orthop 1972;82:108-22.
5. Waddell G, Bircher M, Finlayson D, et al. Symptoms and signs: Physical disease or illness behaviour? Br Med J (Clin Res Ed) 1984;289:739-41.
6. Waddell G. 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine 1987;12632-44.
7. Korbon GA, DeGood DE, Schroeder ME, et al. The development of a Somatic Amplification Rating Scale for low-back pain. Spine 1987;12:787-91.
8. Humphreys SC, Eck JC. Clinical evaluation and treatment options for herniated lumbar disc. Am Fam Physician 1999;59:578-82.
9. Kiester PD, Duke AD. Is it malingering, or is it "real"? Eight signs that point to nonorganic back pain. Postgrad Med 1999;106:77-80, 83-4.
10. Lechner DE, Bradbury SF, Bradley LA. Detecting sincerity of effort: A summary of methods and approaches. Phys Ther 1998;78:867-88.
11. Main CJ, Waddell G. Behavioral responses to examination. A reappraisal of the interpretation of "nonorganic signs". Spine 1998;23:2367-71.
12. Scalzitti DA. Screening for psychological factors in patients with low back problems: Waddell's nonorganic signs. Phys Ther 1997;77:306-12.
13. Institute of Medicine Committee to Advise the Public Health Service on Clinical Practice. Clinical practice guidelines: Directions for a new program. Washington, DC: National Academy Press; 1990.
14. Polatin PB, Cox B, Gatchel RJ, et al. A prospective study of Waddell signs in patients with chronic low back pain. When they may not be predictive. Spine 1997;22:1618-21.
15. Waddell G, Morris EW, Di Paola MP, et al. A concept of illness tested as an improved basis for surgical decisions in low-back disorders. Spine 1986;11:712-9.
16. Main CJ, Wood PL, Hollis S, et al. The Distress and Risk Assessment Method: A simple patient classification to identify distress and evaluate the risk of poor outcome. Spine 1992;17:42-52.
17. Friedrich M, Gittler G, Halberstadt Y, et al. Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial. Arch Phys Med Rehabil 1998;79:475-87.
18. Spratt KF, Lehmann TR, Weinstein JN, et al. A new approach to the low-back physical examination. Behavioral assessment of mechanical signs. Spine 1990;15:96-102.
19. Sobel JB, Sollenberger P, Robinson R, et al. Cervical nonorganic signs: A new clinical tool to assess abnormal illness behavior in neck pain patients: A pilot study. Arch Phys Med Rehabil 2000;81:170-5.
20. McCombe PF, Fairbank JCT, Cockersole BC, et al. Volvo Award in clinical sciences. Reproducibility of physical signs in low-back pain. Spine 1989;14:908-18.
21. Maruta T, Goldman S, Chan CW et al. Waddell's nonorganic signs and Minnesota Multiphasic Personality Inventory profiles in patients with chronic low back pain. Spine 1997;22:72-5.
22. Lehmann TR, Russell DW, Spratt KF. The impact of patients with nonorganic physical findings on a controlled trial of transcutaneous electrical nerve stimulation and electroacupuncture. Spine 1983;8: 625-34.
23. Vendrig AA, de Mey HR, Derksen JJ, et al. Assessment of chronic back pain patient characteristics using factor analysis of the MMPI-2: Which dimensions are actually assessed? Pain 1998;76:179-88.
24. Fishbain DA, Goldberg M, Rosomoff RS, et al. Chronic pain patients and the nonorganic physical sign of nondermatomal sensory abnormalities (NDSA). Psychosomatics 1991;32:294-303.
25. Reesor KA, Craig KD. Medically incongruent chronic back pain: Physical limitations, suffering, and ineffective coping. Pain 1988;32:35-45.
26. Greenough CG. Recovery from low back pain. 1-5 year follow-up of 287 injury-related cases. Acta Orthop Scand Suppl 1993;254:1-34.
27. Novy DM, Collins HS, Nelson DV, et al. Waddell signs: Distributional properties and correlates. Arch Phys Med Rehabil 1998;79:820-2.
28. Greenough CG, Fraser RD. Comparison of eight psychometric instruments in unselected patients with back pain. Spine 1991;16:1068-74.
29. Main CJ, Waddell G. Psychometric construction and validity of the Pilowsky Illness Behaviour Questionnaire in British patients with chronic low back pain. Pain 1987;28:13-25.
30. Doxey NC, Dzioba RB, Mitson GL, et al. Predictors of outcome in back surgery candidates. J Clin Psychol 1988;44:611-22.
31. Dzioba RB, Doxey NC. A prospective investigation into the orthopaedic and psychologic predictors of outcome of first lumbar surgery following industrial injury. Spine 1984;9:614-23.
32. Hirsch G, Beach G, Cooke C, et al. Relationship between performance on lumbar dynamometry and Waddell score in a population with low-back pain. Spine 1991;16:1039-43.
33. Cooke C, Dusik LA, Menard MR, et al. Relationship of performance on the ERGOS work simulator to illness behavior in a workers' compensation population with low back versus limb injury. J Occup Med 1994;36:757-62.
34. Knutsson E, Skoglund CR, Natchev E. Changes in voluntary muscle strength, somatosensory transmission and skin temperature concomitant with pain relief during autotraction in patients with lumbar and sacral root lesions. Pain 1988;33:173-9.
35. Rolak LA. Psychogenic sensory loss. J Nerv Ment Dis 1988;176:686-7.
36. Hernández-Peón R, Chávez-Ibarra, Agilar-Figueroa E. Somatic evoked potentials in one case of hysterical anaesthesia. Electroencephalogr Clin Neurophysiol 1963;15:889-92.
37. Levy R, Behrman J. Cortical evoked responses in hysterical hemianaesthesia. Electroencephalogr Clin Neurophysiol 1970;29:400-2.
38. Levy R, Mushin J. The somatosensory evoked response in patients with hysterical anaesthesia. J Psychosom Res 1973;17:81-4.
39. Fishbain DA, Goldberg M. The misdiagnosis of conversion disorder in a psychiatric emergency service. Gen Hosp Psychiatry 1991;13:177-81.
40. Fishbain DA. Response to "The misdiagnosis of conversion disorder in a psychiatric emergency service". Gen Hosp Psychiatry 1992;14:146-8.
41. Mailis A, Downar J, Nicholson K, et al. MRI in unexplainable widespread somatosensory deficits (WSDs) in patients with chronic pain. American Pain Society meeting, Atlanta, GA; 2000:158.
42. Gould R, Miller BL, Goldberg MA, et al. The validity of hysterical signs and symptoms. J Nerv Ment Dis 1986;174:593-7.
43. Rappaport M. Brain evoked potentials as a tool in psychiatric assessment. J Clin Psychiatry 1982;43: 465-7.
44. Lorenz J, Kunze K, Bromm B. Differentiation of conversive sensory loss and malingering by P300 in a modified oddball task. Neuroreport 1998;9:187-91.
45. Waddell G, Somerville D, Henderson I, et al. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617-28.
46. Chan CW, Goldman S, Ilstrup DM, et al. The pain drawing and Waddell's nonorganic physical signs in chronic low-back pain. Spine 1993;18:1717-22.
47. Menard MR, Cooke C, Locke SR, et al. Pattern of performance in workers with low back pain during a comprehensive motor performance evaluation. Spine 1994;19:1359-66.
48. Cooke C, Menard MR, Beach GN, et al. Serial lumbar dynamometry in low back pain. Spine 1992;17:653-62.
49. Waddell G, Main CJ, Morris EW, et al. Chronic low-back pain, psychologic distress, and illness behavior. Spine 1984;9:209-13.
50. Klenerman L, Slade PD, Stanley IM, et al. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine 1995;20:478-84.
51. McCulloch JA. Chemonucleolysis. J Bone Joint Surg Br 1977;59:45-52.
52. Lacroix JM, Powell J, Lloyd GJ, et al. Low-back pain. Factors of value in predicting outcome. Spine 1990;15:495-9.
53. Lancourt J, Kettelhut M. Predicting return to work for lower back pain patients receiving worker's compensation. Spine 1992;17629-40.
54. Gaines WG Jr, Hegmann KT. Effectiveness of Waddell's nonorganic signs in predicting a delayed return to regular work in patients experiencing acute occupational low back pain. Spine 1999;24: 396-400; discussion 401.
55. McIntosh G, Frank J, Hogg-Johnson S, et al. Prognostic factors for time receiving workers' compensation benefits in a cohort of patients with low back pain. Spine 2000;25:147-57.
56. Kummel BM. Nonorganic signs of significance in low back pain. Spine 1996;21:1077-81.
57. Bradish CF, Lloyd GJ, Aldam CH, et al. Do nonorganic signs help to predict the return to activity of patients with low-back pain? Spine 1988;13:557-60.
58. Fritz JM, Wainner RS, Hicks GE. The use of nonorganic signs and symptoms as a screening tool for return-to-work in patients with acute low back pain. Spine 2000;25:1925-31.
59. Werneke MW, Harris DE, Lichter RL. Clinical effectiveness of behavioral signs for screening chronic low-back pain patients in a work-oriented physical rehabilitation program. Spine 1993;18: 2412-8.
60. Hayes B, Solyom CA, Wing PC, et al. Use of psychonictric measures and nonorganic signs testing in detecting nomogenic disorders in low back pain patients. Spine 1993;18:1254-9.
61. Gracovetsky SA, Newman NM, Richards MP, et al. Evaluation of clinician and machine performance in the assessment of low back pain. Spine 1998;23: 568-75.
62. Rucker KS, Metzler HM, Kregel J. Standardization of chronic pain assessment: A multiperspective approach. Clin J Pain 1996;12:94-110.
63. Waddell G, Richardson J. Observation of overt pain behaviour by physicians during routine clinical examination of patients with low back pain. J Psychosom Res 1992;36:77-87.
64. Watson PJ, Poulter ME. The development of a functional task-oriented measure of pain behaviour in chronic low back pain patients. J Back Musculosketal Rehabil 1997;9:57-9.
65. Ohlund C, Lindstrom I, Areskoug B, et al. Pain behavior in industrial subacute low back pain. Part I. Reliability: Concurrent and predictive validity of pain behavior assessments. Pain 1994;58:201-9.
66. Dirks HF, Wunder J, Reynolds J, et al. A scale for predicting nonphysiological contributions to pain. Psychother Psychosom 1996;65:153-7.
67. Fishbain DA, Goldberg M, Ferretti T, et al. The nondermatomal sensory abnormality (NDSA) and pain perception. Pain 1990;5(suppl):S332.
68. Karas R, McIntosh G, Hall H, et al. The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain. Phys Ther 1997;77: 354-60, discussion 361-9.
69. Kaziyama HHS, Teixeira TY Lin, Teixeira M. Fibromyalgia and hemisensitive syndromes. IASP 9th World Congress meeting, Vancouver, Canada; 1999:550.
70. Walters A. Psychogenic regional pain alias hysterical pain. Brain 1961;84:1-18.
71. Kool JP, Oesd PR, DeBe RA. Predictive tests for non-return to work in patients with chronic low back pain. Eur Spine J 2002;11:258-66.
72. Hoogendoorn WE, van Poppel MN, Bongers PM, et al. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine 2000;25:2114-25.
73. de Vet H, de Bie R, van der Heijden G, et al. Systematic reviews on the basis of methodological criteria. Physiotherapy 1997;83:284-9.
74. Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: A systematic review. Pain 1998;77:1-13.
75. Shealy CN. A physiological basis for "hysterical" analgesia. Headache 1971;11:102-6.
76. Mersky H. Regional pain is rarely hysterical. Arch Neurol 1988;45:915-8.
77. Tal M, Bennett GJ. Extra-territorial pain in rats with a peripheral mononeuropathy: Mechanohyperalgesia and mechano-allodynia in the territory of an uninjured nerve. Pain 1994;57:375-82.
78. Nathan PW. Improvement in cutaneous sensibility associated with relief of pain. J Neurol Neurosurg Psychiatry 1960:23:202-6.
79. Moriwaki K, Yuge O. Topographical features of cutaneous tactile hypoesthetic and hyperesthetic abnormalities in chronic pain. Pain 1999;81:1-6.
80. Sola AE, Kuitert JH. Myofascial trigger point pain in the neck and shoulder girdle. Northwest Med 1955;54:980-4.
81. Simons DG, Travell JG. Myofascial origins of low back pain. Postgrad Med 1983;73:66-108.
82. Margoles MS. Clinical assessment and interpretation of abnormal illness behaviour in low back pain, G. Waddell, I. Pilowsky and M. Bond, Pain, 39 (1989) 41-53. Pain 1990;42:258-9.
83. Graven-Nielsen T, Arendt-Nielsen L, Svensson P, et al. Stimulus-response functions in areas with experimentally induced referred muscle pain - a psychophysical study. Brain Res 1997;744:121-8.
84. Svensson P, McMillan AS, Graven-Nielsen T, et al. Modulation of an inhibitory reflex in single motor units in human masseter by tonic painful stimulation. Pain 1999;83:441-6.
85. Sohn MK, Graven-Nielsen T, Arendt-Nielsen L, et al. Inhibition of motor unit firing during experimental muscle pain in humans. Muscle Nerve 2000;23:1219-26.
86. Taimela S, Kankaanpaa M, Airaksinen O. A submaximal back extension endurance test utilising subjective perception of low back fatigue. Scand J Rehabil Med 1998;30:107-12.
87. Kosek E, Ekholm J, Hansson P. Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 1996,68:375-83.
88. Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain 1996;65:259-64.
89. Ferrari R, Russell AS. Letter to the editor. Spine 1999;24:306.
90. Bendtsen L, Norregaard J, Jensen R, et al. Evidence of qualitatively altered nociception in patients with fibromyalgia. Arthritis Rheum 1997;40:98-102.
91. Nicassio PM, Weisman MH, Schuman C, et al. The role of generalized pain and pain behavior in tender point scores in fibromyalgia. J Rheumatol 2000;27: 1056-62.
92. Rommel O, Gehling M, Dertwinkel R, et al. Hemisensory impairment in patients with complex regional pain syndrome. Pain 1999;80:95-101.
93. Thimineur M, Sood P, Kravitz E, et al. Central nervous system abnormalities in complex regional pain syndrome (CRPS): Clinical and quantitative evidence of medullary dysfunction. Clin J Pain 1998;14:256-67.
94. Anderson TP. Positive physical findings confirming chronic pain syndrome. A clinical commentary. Am J Phys Med Rehabil 1991;70:157-8.
95. Cooper HM. Scientific guidelines for conducting integrative reviews. Rev Educ Res 1982;52:291-302.
96. Jackson GB. Methods for integrative review Rev. Educ Res 1980;50:438-60.
97. Bangert-Drowns RL. Review of developments in meta-analysis methods. Psychol Bull 1986;99:388-99.
98. Pollock VE. Meta-analysis in literature reviews. Biol Psychiatry 1993;34:345-7.
99. Rosomoff HL, Fishbain DA, Goldberg M, et al. Physical findings in patients with chronic intractable benign pain of the neck and/or back. Pain 1989;37:279-87.