What does the concept of "non-organic signs/symptoms" mean to chiropractic MSK specialists?

Introduction 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.1 In that and other early work, high NOS scores were thought to indicate the need for further psychological assessment of the spine pain patient.2 In a more recent work, Main and Waddell have clarifi ed that, all along, they considered NOSS to be associated with higher levels of distress and illness behaviour.3 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. Numerous studies have appeared since 1980 on the use of NOS in low back pain patients, many of which confi rm the association of NOS with certain psychological variables and with poorer prognosis.4–15 NOS have also been applied in the cervical spine.16–18 However, critical reviews have emerged which challenge some popular assertions about NOS.19 Most important among these critiques is the work of Fishbain et al.20,21 whose systematic reviews of the literature fi nd very little empirical support for many of the psychological associations with NOSS and almost no support for the correlation between NOSS and malingering. In light of these controversies, it seemed appropriate to inquire as to the meaning of NOSS among some of those practitioners who specialize in spine pain assessments. Chiropractors in general, and chiropractic MSK specialists and third-party assessors in particular, may have implicit attitudes about NOSS which may not have been explicitly explored by themselves and which have never been explicitly examined or analyzed for their consistency with others in similar roles. As well, these implicit attitudes may be predicated on faulty justifi cations that are not evidenced-based. In order to identify if this is the case, a small survey of these attitudes was undertaken. What does the concept of “non-organic signs/symptoms” mean to chiropractic MSK specialists?