Waddell (Nonorganic) Signs and Their Association with Interventional Treatment Outcomes for Low Back Pain —Anesthesia & Analgesia

Cohen SP, Doshi T, Kurihara C, Dolomisiewicz E, Liu RC, Dawson TC, Hager N, Durbhakula S, Verdun AV, Hodgson JA, Pasquina P

The rising use of injections to treat low back pain (LBP) has led to efforts to improve selection. Nonorganic (Waddell) signs have been shown to portend treatment failure for surgery and other therapies but have not been studied for minimally invasive interventions. This study prospectively evaluated the association between Waddell signs and treatment outcome in 3 cohorts: epidural steroid injections (ESI) for leg pain and sacroiliac joint (SIJ) injections and facet interventions for LBP. Categories of Waddell signs included nonanatomic tenderness, pain during sham stimulation, discrepancy in physical examination, overreaction, and regional disturbances divulging from neuroanatomy. The primary outcome was change in patient-reported “average” numerical rating scale for pain intensity (average NRS-PI), modeled as a function of the number of Waddell signs using simple linear regression. Secondary outcomes included a binary indicator of treatment response. Secondary and sensitivity analyses were conducted to account for potential confounders. Whereas this study found no consistent relationship between Waddell signs and decreased mean pain scores, a significant relationship between the number of Waddell signs and treatment failure was observed.

Cohen, S., Doshi, T., Kurihara, C., Dolomisiewicz, E., Liu, R., Dawson, T., Hager, N., Durbhakula, S., Verdun, A., Hodgson, J., & Pasquina, P. (2021). Waddell (Nonorganic) Signs and Their Association with Interventional Treatment Outcomes for Low Back Pain. Anesthesia & Analgesia. https://doi.org/10.1213/ANE.0000000000005054