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Waddell's signs are a group of physical signs, named after the orthopedic surgeon Gordon Waddell, used to assess if a patient is experiencing chronic pain related to psychological or emotional distress rather than from a physical cause. They are often used in the field of occupational medicine.

Overview

Waddell's signs are not meant to suggest malingering or faking, but rather to indicate that other treatment methods, such as cognitive behavioral therapy, may be more effective than surgery or physical therapy. The signs are divided into five categories: superficial and widespread tenderness, simulation, distraction, regional disturbances, and overreaction.

Categories of Waddell's Signs

Superficial and Widespread Tenderness

Superficial tenderness is pain that occurs with light touch to the skin over a wide area of the lower back. Widespread tenderness is pain that occurs in a large area of the back, not limited to the area of injury.

Simulation

Simulation signs are those that occur when the patient's pain appears to be related to an improbable cause. For example, if a patient reports severe pain from a light touch or from a test that should not cause pain.

Distraction

Distraction signs are those that change when the patient's attention is diverted. For example, if a patient reports pain from a certain movement when they are watching, but not when they are distracted.

Regional Disturbances

Regional disturbances are signs that do not follow known anatomical or neurological patterns. For example, a patient may report numbness or weakness in an entire leg, rather than in a specific dermatome or myotome.

Overreaction

Overreaction signs are those that involve an excessive display of pain or distress, such as grimacing, groaning, or collapsing, that seems out of proportion to the stimulus.

Clinical Significance

Waddell's signs are used in conjunction with a patient's history and other physical examination findings to help differentiate between physical and non-physical components of pain. They are not diagnostic of a specific condition, but rather suggest that the patient's pain may have a significant non-physical component.

See Also

• Chronic pain
• Occupational medicine
• Cognitive behavioral therapy

References

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