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Keywords:

  • Nonorganic Physical Signs;
  • Waddell Signs;
  • Nondermatomal Sensory Abnormalities;
  • Malingering;
  • Chronic Pain;
  • Secondary Gain;
  • Conversion Disorder

ABSTRACT

objectives. Nondermatomal sensory abnormalities (NDSAs) are alleged to be nonorganic physical findings, where one finds diminished sensation to light touch, pinprick, and, sometimes, other modalities fitting a “nondermatomal pattern.” The presence of NDSAs has historically been classified as a conversion symptom. We wished to determine if, in chronic pain patients (CPPs), NDSA location was associated with pain location.

methods. The setting was a multidisciplinary pain facility. Patients included in the study were those CPPs who, on physical examination by two independent examiners, were found to have NDSAs. NDSA location and pain location were recorded for each CPP. Chi-square analyses (Fisher exact tests) and Kappa statistics were used to test for a relationship between NDSA location and pain location in three patient groups: Pain, upper body only; pain, lower body only; and pain, both lower and upper body.

results. Of 283 consecutive CPPs, 74 were found to have NDSAs, by both examiners, and to fulfill the inclusion criteria of this study. The relationship between NDSA location and pain location was found to be significant (Fisher exact test) for all three patient subsets: Upper body P < 0.05, lower body P < 0.0001, and upper and lower body P < 0.000001. Similarly, the relationship between NDSA location and pain location was found to be statistically significant for all three patient subsets using the Kappa statistic.

conclusions. The findings of this study suggest that NDSA location is associated with perceived pain location. This finding has implications for whether the presence of NDSAs is considered a conversion symptom.