Fishbain DA, Cutler RB, et al. Is there a relationship between nonorganic physical findings (Waddell Signs) and Secondary Gain/Malingering? 2004; 20: 399-408.
It will take a while before Waddell Signs are dropped because many practitioners have yet to understand the science of pain (ironic, since we spend more money in the US on the management of pain, compared to any other sign, symptom or condition). As a judge, are you able to question the ethics of an expert presenting information that has questionable validity?
So with our understanding of Central Sensitization, do you suspect the Waddell signs tell us a malingerer OR someone with a sensitized nervous system? Can these tests be dumped from our infamous bag of tricks? I think so….
When was the last time you have questioned a patient due to the non-anatomical features related to their work-related injury? When was the last time you utilized Waddell signs to screen for malingering? I want to propose the argument that, in the light of recent developments in our understanding of pain neurophysiology, we should be very reserved in questioning our patient’s complaints. In addition, I believe it is time that we drop the Waddell signs in the screening for potential malingering/secondary gain due to lack of validity in the face of research on central sensitization.