Waddell (Nonorganic) Signs and Their Association With Interventional Treatment Outcomes for Low Back Pain
Waddell (Nonorganic) Signs and Their Association With Interventional Treatment Outcomes for Low Back Pain
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DOI：
10.1213/ane.0000000000005054
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发表时间：
2021-03-01
影响因子：
5.7
通讯作者：
Pasquina, Paul F.
中科院分区：
文献类型：
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作者：
Cohen, Steven P.;Doshi, Tina L.;Pasquina, Paul F.
背景：注射治疗腰痛（LBP）的使用越来越多，导致了改善选择的努力。非器质性（Waddell）的迹象已被证明预示着治疗失败的手术和其他疗法，但还没有研究微创interventions.METHODS：我们前瞻性评估Waddell迹象和治疗结果之间的关联在3个队列：硬膜外类固醇注射（ESI）的腿部疼痛和骶髂关节（SIJ）注射和小关节干预LBP。Waddell征的分类包括非解剖性压痛、假刺激时疼痛、体格检查差异、过度反应和神经解剖学泄露的区域性紊乱。主要结局是患者报告的疼痛强度“平均”数值评定量表（平均NRS-PI）的变化，使用简单线性回归将其建模为Waddell体征数量的函数。次要结局包括治疗反应的二元指标。我们进行了二次和敏感性分析，以解释潜在的confers.RESULTS：我们招募了318例患者：152在ESI队列，102在小关节队列，和64在SIJ队列，有足够的数据进行初步分析的308例患者。其中62%（n = 192）无Waddell征象，18%（n = 54）有1个征象，11%（n = 33）有2个征象，5%（n = 16）有3个征象，2%（n = 7）有4个征象，约2%（n = 6）有所有5个征象。这6组中，每组的平均NRS-PI的平均变化分别为-1.6 +/- 2.6、-1.1 +/- 2.7、-1.5 +/- 2.5、-1.6 +/- 2.6、-1 +/- 1.5和0.7 +/- 2.1，其相应的治疗失败率为54%（102/192）、67%（36/54）、70%（23/33）、75%（12/16）、71%（5/7）和83%（5/6）。在主要分析中，Waddell征数量的增加与平均NRS-PI的显著降低无关（系数[Coef] = 0.19; 95%置信区间[CI]，-0.43至0.05; P = 0.12）。较高数量的Waddell体征与治疗失败相关，每累积体征数量治疗失败的几率增加1.35（P = .008）。结论：尽管本研究发现Waddell体征与平均疼痛评分降低之间没有一致的关系，但观察到Waddell体征数量与治疗失败之间存在显著关系。
BACKGROUND: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.METHODS:We 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. We conducted secondary and sensitivity analyses to account for potential confounders.RESULTS:We enrolled 318 patients: 152 in the ESI cohort, 102 in the facet cohort, and 64 in the SIJ cohort, having sufficient data for primary analysis on 308 patients. Among these, 62% (n = 192) had no Waddell signs, 18% (n = 54) had 1 sign, 11% (n = 33) had 2, 5% (n = 16) had 3, 2% (n = 7) had 4, and about 2% (n = 6) had all 5 signs. The mean change in average NRS-PI in each of these 6 groups was -1.6 +/- 2.6, -1.1 +/- 2.7, -1.5 +/- 2.5, -1.6 +/- 2.6, -1 +/- 1.5, and 0.7 +/- 2.1, respectively, and their corresponding treatment failure rates were 54% (102 of 192), 67% (36 of 54), 70% (23 of 33), 75% (12 of 16), 71% (5 of 7), and 83% (5 of 6). In the primary analysis, an increasing number of Waddell signs were not associated with a significant decrease in average NRS-PI (coefficient [Coef] = 0.19; 95% confidence interval [CI], -0.43 to 0.05; P = .12). A higher number of Waddell signs were associated with treatment failure, with a 1.35 increased odds of treatment failure per cumulative number of signs (P = .008).CONCLUSIONS: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.