Abstract
Introduction Waddell’s signs and symptoms have been described as patient presentations not within usual anatomic patterns of injury pathology. Waddell’s signs were thought to indicate psychological distress and were termed “non-organic findings”; similarly, Waddell’s symptoms were described as inappropriate and attributable to psychological features. Endorsement of more than two of Waddell’s symptoms is thought to be associated with psychological distress, disability, and poor treatment outcomes; however, this has not been empirically assessed. Methods The current study used a sample of patients (n = 108; 30% women) involved in a multi-disciplinary work hardening program provided by a third-party insurer. Patients who endorsed more than two of Waddell’s symptoms were compared with those who did not on demographic variables as well as self-report measures of psychological distress, disability, and treatment outcome. Results Patients who endorsed more than two of Waddell’s symptoms reported higher levels of psychological distress, perceived disability, pain intensity, and pain durations. Moreover, consistent with previous research on Waddell’s symptoms, patients endorsing more than two symptoms were also less likely to return to work. Conclusions Waddell’s symptoms were associated with increased perceived disability and pervasive pain interference. Patients who endorsed more than two symptoms were significantly less likely to return to work than those who endorsed zero, one, or two symptoms. Patients who endorsed more than two symptoms may indeed be affected by factors beyond tissue pathology that nonetheless warrant clinical attention. Waddell’s symptoms appear to have promise as a quick indicator of treatment complexity and outcome.
Similar content being viewed by others
References
Main CJ. The nature of chronic pain: a clinical and legal challenge. In: Hallingan PW, Bass C, Oakley DA, editors. Malingering and illness deception. New York: Oxford University Press; 2003. p. 171–83.
Asmundson GJG, Wright KD. Biopsychosocial approaches to pain. In: Hadjistavropoulos T, Craig KD, editors. Pain: psychological perspectives. Mawah: Erlbaum; 2004. p. 13–34.
Hadjistavropoulos T, Craig KD, editors. Pain: psychological perspectives. Mahwah: Erlbaum; 2005.
Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32. doi:10.1016/S0304-3959(99)00242-0.
Turk DC, Meichenbaum D, Genest M. Pain and behavioral medicine: a cognitive-behavioral perspective. New York: Guilford Press; 1983.
Asmundson GJG, Vlaeyen JWS, Crombez G, editors. Understanding and treating fear of pain. New York: Oxford; 2004.
Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine. 1980;5:117–25. doi:10.1097/00007632-198003000-00005.
Collie J. Malingering and feigned sickness. London: Edward Arnold; 1913.
Main CJ, Waddell G. Behavioral responses to examination. A reappraisal of the interpretation of “nonorganic signs”. Spine. 1998;23:2367–71. doi:10.1097/00007632-199811010-00025.
Thompson E. Psychogenic pain and somatization: past history and present status. Canadian pain society conference. Halifax, NS; 2005.
Gallagher RM. Waddell signs: objectifying pain and the limits of medical altruism. Pain Med. 2003;4:113–5. doi:10.1046/j.1526-4637.2003.03023.x.
Centeno CJ, Elkins WL, Freeman M. Waddell’s signs revisited? Spine. 2004;29:1392. doi:10.1097/01.BRS.0000128771.48789.FB. (discussion 3).
Giles LG. Re: Centeno CJ, Elkins WL, Freeman M. Editorial. Waddell’s signs revisited? Spine 2004;29:1392. Spine. 2005;30:265–8.
Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HL, Rosomoff RS. A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Med. 2003;4:141–81. doi:10.1046/j.1526-4637.2003.03015.x.
Fishbain DA. Waddell Signs. Pain Med. 2003;4:386–7. doi:10.1111/j.1526-4637.2003.3043b.x. (reply).
Waddell G, Bircher M, Finlayson D, Main CJ. Symptoms and signs: physical disease or illness behaviour? Br Med J. 1984;289:739–41.
Waddell G, Main CJ, Morris EW, Di Paola M, Gray IC. Chronic low-back pain, psychologic distress, and illness behavior. Spine. 1984;9:209–13. doi:10.1097/00007632-198403000-00013.
Matheson L. The functional capacity evaluation program. In: Andersson G, Demeter S, Smith G, editors. Disability evaluation. 2nd ed. Chicago: Mosby Yearbook; 2003.
Schultz IZ, Crook J, Berkowitz J, Milner R, Meloche GR. Predicting return to work after low back injury using the psychosocial risk for occupational disability instrument: a validation study. J Occup Rehabil. 2005;15:365–76. doi:10.1007/s10926-005-5943-9.
Asmundson GJG, Carleton RN, Ekong J. Dot-probe evaluation of selective attentional processing of pain cues in patients with chronic headaches. Pain. 2005;114:250–6. doi:10.1016/j.pain.2004.12.025.
Norton PJ, Asmundson GJ. Anxiety sensitivity, fear, and avoidance behavior in headache pain. Pain. 2004;111:218–23. doi:10.1016/j.pain.2004.06.018.
Reesor KA, Craig KD. Medically incongruent chronic back pain: physical limitations, suffering, and ineffective coping. Pain. 1988;32:35–45. doi:10.1016/0304-3959(88)90021-8.
Dalton JA, Feuerstein M. Fear, alexithymia and cancer pain. Pain. 1989;38:159–70. doi:10.1016/0304-3959(89)90234-0.
Miller MB. Coefficient alpha: a basic introduction from the perspectives of classical test theory and structural equation modeling. Struct Equ Modeling. 1995;2:255–73.
Lawlis GF, Cuencas R, Selby D, McCoy CE. The development of the Dallas pain questionnaire. An assessment of the impact of spinal pain on behavior. Spine. 1989;14:511–6. doi:10.1097/00007632-198905000-00007.
Hudson-Cook N, Tomes-Nicholson K, Breen AA. Revised oswestry disability questionnaire. In: Roland MO, Jenner JR, editors. Back pain: new approaches to rehabilitation and education. New York: Manchester University Press; 1989. p. 187–204.
Melzack R, Perry C. Self-regulation of pain: the use of alpha-feedback and hypnotic training for the control of chronic pain. Exp Neurol. 1975;46:452–69. doi:10.1016/0014-4886(75)90119-3.
Melzack R. The McGill pain questionnaire. In: Melzack R, editor. Pain measurement and assessment. New York: Raven Press; 1983. p. 41–7.
Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nursing. 2005;14:798–804. doi:10.1111/j.1365-2702.2005.01121.x.
Gallagher EJ, Bijur PE, Latimer C, Silver W. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002;20:287–90. doi:10.1053/ajem.2002.33778.
Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153–7. doi:10.1111/j.1553-2712.2001.tb01132.x.
Jamison RN, Gracely RH, Raymond SA, Levine JG, Marino B, Herrmann TJ, et al. Comparative study of electronic versus paper VAS ratings: a randomized, crossover trial using healthy volunteers. Pain. 2002;99:341–7. doi:10.1016/S0304-3959(02)00178-1.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Mawah: Erlbaum; 1988.
Tabachnick BG, Fidell LS. Using multivariate statistics. 4th ed. New York: Harper and Row; 2001.
Judd CM, McClelland GH, Culhane SE. Data analysis: continuing issues in the everyday analysis of psychological data. Annu Rev Psychol. 1995;46:433–65. doi:10.1146/annurev.ps.46.020195.002245.
Groth-Marnat G. Handbook of psychological assessment. 4th ed. New York: Wiley; 2003.
Asmundson GJG, Norton PJ, Vlaeyen JWS. Fear-avoidance models of chronic pain: an overview. In: Asmundson GJG, Vlaeyen JWS, Crombez G, editors. Understanding and treating fear of pain. Oxford: Oxford University Press; 2004. p. 3–24.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psych Meas. 1977;1:385–401. doi:10.1177/014662167700100306.
McCracken LM, Dhingra L. A short version of the pain anxiety symptoms scale (PASS-20): preliminary development and validity. Pain Res Manag. 2002;7:45–50.
Abrams MP, Carleton RN, Asmundson GJG. An exploration of the psychometric properties of the PASS-20 with a nonclinical sample. J Pain. 2007;8:879–86. doi:10.1016/j.jpain.2007.06.004.
Asmundson GJG, Carleton RN. Fear of pain. In: Antony MM, Stein MB, editors. Handbook of anxiety and the anxiety disorders. New York: Oxford University Press; 2008. p. 551–61.
Asmundson GJG, Norton PJ, Veloso F. Anxiety sensitivity and fear of pain in patients with recurring headaches. Behav Res Ther. 1999;37:703–13. doi:10.1016/S0005-7967(98)00172-7.
Carleton RN, Sharpe D, Asmundson GJG. Anxiety sensitivity and intolerance of uncertainty: requisites of the fundamental fears? Behav Res Ther. 2007;45:2307–16. doi:10.1016/j.brat.2007.04.006.
Carleton RN, Asmundson GJG, Taylor S. Fear of physical harm: factor structure and psychometric properties of the injury/illness sensitivity index. J Psychopathol Behav. 2005;27:235–41. doi:10.1007/s10862-005-2403-y.
Carleton RN, Park I, Asmundson GJG. The illness/injury sensitivity index: an examination of construct validity. Depress Anxiety. 2006;23:340–6. doi:10.1002/da.20138.
Acknowledgments
Dr. Asmundson is supported by a Canadian Institutes of Health Research (CIHR) Investigator Award; R. N. Carleton is supported by a CIHR Canada Graduate Scholarship Doctoral Research Award; and M. P. Abrams is supported by a CIHR Canada Graduate Scholarship Doctoral Research Award.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carleton, R.N., Kachur, S.S., Abrams, M.P. et al. Waddell’s Symptoms as Indicators of Psychological Distress, Perceived Disability, and Treatment Outcome. J Occup Rehabil 19, 41–48 (2009). https://doi.org/10.1007/s10926-009-9165-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10926-009-9165-4