- Waddell's signs
Waddell's signs are a group of physical signs, first described by Waddell "et al" in 1980, [cite journal | author=Waddell G, McCulloch JA, Kummel E, Venner RM | title=Nonorganic physical signs in low-back pain | journal=Spine | year=1980 | pages=117–25 | volume=5 | pmid=6446157 | doi=10.1097/00007632-198003000-00005] that may indicate non-organic or
psychological component to chroniclow back pain . Historically they have been used to detect "malingering " patients with back pain.Use of Waddell's Signs
One or two Waddell's signs can often be found even when there is not a strong non-organic component to pain. Three or more are positively correlated with high scores for depression,
hysteria andhypochondria sis on theMinnesota Multiphasic Personality Inventory .Waddell's signs are:
# Superficial tenderness – skin discomfort on light palpation.
# Nonanatomic tenderness – tenderness crossing multiple anatomic boundaries.
# Axial loading – eliciting pain when pressing down on the top of the patient’s head.
# Pain on simulated rotation - rotating the shoulders and pelvis together should not be painful as it does not stretch the structures of the back.
# Distracted straight leg raise - if a patient complains of pain on straight leg raise, but not if the examiner extends the knee with the patient seated (e.g. when checking theBabinski reflex).
# Regional sensory change - Stocking sensory loss, or sensory loss in an entire extremity or side of the body.
# Regional weakness - Weakness that is jerky, with intermittent resistance (such as cogwheeling, or catching). Organic weakness can be overpowered smoothly.
# Overreaction - Exaggerated painful response to a stimulus, that is not reproduced when the same stimulus is given later.Although Waddell's signs can detect a non-organic component to pain, they do not exclude an organic cause. A high Waddell score (>3) is indicative only of symptom magnification or possible illness behavior. Often the test has been misused.Fact|date=April 2008 It does not signify malingering.
According to an original article the actual numbers of Waddell's signs are 5: (Waddell G, McCulloch HA, Kummel E, Venner RM. Non-organic physical signs in low-back pain. Spine 1980; 5: 117-25)
* 1. Superficial and Widespread tenderness or Nonanatomic tenderness. (It's "one" sign)
* 2. Stimulation tests: Axial loading and Pain on simulated rotation. (It's another "one" sign)
* 3. Distracted straight leg raise.
* 4. Non-anatomic sensory changes: Regional sensory changes and Regional weakness.(It's another "one" sign)
* 5. Overreaction.If there are more than 3 of 5 present then there is high probability that patient has non-organic pain.
Waddell signs do not reliably distinguish organic from psychological pain but instead tend to underestimate the amount of pain that is actually experienced. (Fishbain, Cole, Cutler, Lewis, Rosomoff, & Rosomoff, A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Medicine. 4(2):141-81, 2003 Jun.)
External links
* [http://neuroland.com/spine/lbp_nonorganic_sign.htm Neuroland, Signs suggestive of non-organic back pain]
References
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