Excerpt: Non-organic signs and symptoms (NOS) have been included in assessments of spine pain patients for decades, originating with Waddell et al.’s seminal 1980 study. In that and other early work, high NOS scores were thought to indicate the need for further psychological assessment of the spine pain patient. In a more recent work, Main and Waddell have clarified that, all along, they considered NOSS to be associated with higher levels of distress and illness behaviour. They noted that other interpretations of high NOS scores had entered the literature and the general discourse on spine pain patients, including considerations of malingering or insincere effort. They cautioned that these interpretations were not part of the original considerations for NOS.
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