Waddell signs as behavioral indicators of depression and anxiety in chronic pain

Abstract

In 1980, Waddell et al. proposed that the presence of psychological factors in chronic low back pain patients could be efficiently assessed by the use of five “non-organic” physical symptoms [15]. However, subsequent research on this relationship has been equivocal [5]. In this study, 99 patients completed measures of depression and anxiety and were divided into two groups based on the traditional cut-off score of three or more Waddell signs. Group comparisons indicated that patients with three or more Waddell signs endorsed more depressive and anxious symptoms, even when controlling for pain severity and duration. Examination of mean scores showed a more pronounced difference between patients with two or more Waddell signs and those with one or none. Results suggest that Waddell signs can be an efficient means of identifying chronic low back pain patients who may be depressed or anxious, although the traditional cut-off score may be too conservative in some populations.