First described in 1984, they are thought to be indicators of a psychological component to pain. Also called inorganic or nonorganic signs, these are behavioral responses during physical examination. The eight original signs include: 1) superficial tenderness; 2) nonanatomic tenderness, 3) pain in response to axial loading (vertical downward pressure on the top of the head when standing); 4) back pain in response to simultaneous rotation of the shoulders and pelvis; 5) improved straight leg raise response when distracted; 6) weakness not consistent with normal neurologic function; 7) sensory loss that does not follow a dermatomal pattern (area of skin supplied by cutaneous branches from a single spinal nerve); and 8) “overreaction” to the physical examination. Historically and sometimes inappropriately they have been used to detect and/or accuse patients with back pain as “malingering”.
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