Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Physical Exam

What should a physical examination reveal about a patient’s physical suitability to proceed to the screening trial?

In some pain states, especially early in their course, it is possible that no abnormalities will appear during a thorough physical examination. Any abnormalities and/or physical signs (e.g., Waddell has described non-specific, “nonorganic physical signs in low back pain”) that do appear, however, should be evaluated for consistency with the patient’s pain. The examination might reveal potentially disabling neurologic deficits and/or somatic or functional components of the pain.

Strength of recommendation Evidence sources/rationale
B = Recommended
Uncertain validity, apparently useful
  • Weighing risk versus potential benefit and expert consensus reveals a good likelihood of a favorable outcome

Waddell G, McCulloch JA, Kummel EG, Venner RM. Nonorganic physical signs in low back pain. Spine 5(2):117-125, 1980.

Villavicencio AT, Burneikiene S. Elements of the pre-operative workup, case examples. Pain Med 7 Suppl 1:S35-46, 2006.
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Prager J, Jacobs M. Evaluation of patients for implantable pain modalities: medical and behavioral assessment. Clin J Pain 17(3):206-214, 2001.

Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HL, Rosomoff RS. A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Med 4(2):141-81, 2003.

Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain?. JAMA 268:760-765, 1992.