Study: 40-Year-Old Technique Can Guide TFSI Treatment Decisions

Back and neck pain are two of the most common complaints heard in doctor’s offices throughout the U.S. Unfortunately, it is not always easy for doctors to uncover the root causes of a person’s pain. Likewise, it’s not always easy to decide whether a treatment known as transforaminal epidural steroid injection (TFSI) will actually work.

The pain medicine doctors at Texas-based Lone Star Pain Medicine explain that TFSI is an injection therapy sometimes used to treat organic back pain. Organic back pain is pain associated with a direct anatomic cause, like spinal stenosis or a herniated disk. Non-organic back pain has no known anatomic association. That being the case, TFSI is not the best therapy when pain is non-organic.

Use the Waddell Signs

Given the difficulty of figuring out exactly what causes non-organic back pain, a group of researchers from four different institutions, including John’s Hopkins and the Walter Reed National Military Medical Center, decided to look at a 40-year-old technique for determining pain origin to see if it would have any effect on making decisions about TFSI.

The technique involves looking for a series of eight physical signs known as Waddell signs. The signs were developed by Professor Gordon Waddell in the 1980s as a way to determine whether patients suffering from back pain would benefit from surgery. A doctor can test for the signs during a standard clinical exam and make a determination in a matter of minutes.

The eight signs are divided into five test categories:

  • Superficial tenderness
  • Pain simulation
  • Pain distraction
  • Regional disturbances
  • Overreaction to touch.

It should be noted that not all doctors and pain specialists agree that the Waddell exam can be trusted completely. The exam has long been used in worker’s comp cases to determine whether a patient is faking back pain. As such, numerous studies have been done in hopes of determining its accuracy as a diagnostic tool.

What the Study Revealed

For this latest study, the researchers enrolled 78 patients suffering from neck pain. Each patient was given a clinical examination using the Waddell signs prior to receiving TFSI injections. To summarize, the researchers discovered that the patients exhibiting a greater number of Waddell signs were less likely to benefit from the injections.

Lone Star doctors point out that each Waddell sign that a patient exhibits indicates pain is non-organic. This lines up with the theory posited by the researchers: more signs increase the chances that pain is non-organic and, therefore, would not be helped by an injection therapy.

Researchers concede that the idea of using Waddell signs to determine the likelihood that TFSI will work needs more study. But for now, they say that doctors can look for the signs during a clinical exam to help determine whether a patient’s pain is organic.

No Treatment Is Perfect

If a Waddell exam can accurately predict whether pain is organic or non-organic, it gives pain doctors one more tool for figuring out the best possible treatment. What must always be understood is that no treatment is perfect. The chances are pretty good that a person suffering from non-organic back pain will not benefit from TFSI. But it is also likely that a fair number of patients with organic pack pain will not benefit from the treatment either.

The point of using the Waddell exam appears to be weeding out those non-organic pain patients for whom TFSI is most likely not going to help. They are candidates for some other treatment. Meanwhile, TFSI can be utilized for patients whose pain is determined to be organic.

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