Journal of occupational rehabilitation
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Fear-anxiety-avoidance models of chronic pain emphasize psychological constructs as key vulnerabilities for the development and maintenance of disabling chronic pain. Complementarily, Waddell described physical signs and symptoms thought inconsistent with anatomic and pathologic disease patterns that might function as indications of pain-related psychological distress. Research has not supported using Waddell's signs due to low inter-rater reliability and limited associations with psychological distress; however, these findings are equivocal. Similarly, theorists have suggested that endorsement of Waddell's symptoms may indicate psychological distress; however, the precedent research has not included the psychological constructs described in fear-anxiety-avoidance models as vulnerability factors for the development and maintenance of chronic pain. ⋯ While Waddell's symptoms must still be interpreted judiciously, they may provide much needed cross-disciplinary utility as indicators that more detailed psychological assessment is warranted. Comprehensive implications and directions for future research are discussed.