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Letters to the Editor
December 2000

Comment on Berry and Hachinski—Reply

Arch Neurol. 2000;57(12):1792. doi:

In reply

My understanding of the chronic whiplash syndrome is, of course, in agreement with Dr Ferrari's "biopsychosocial model," that is to say, an approach that recognizes that functional disorders are primarily influenced by the context (historical, social, legal) in which they occur1 and by the way in which this context will determine the attention and value given to the symptoms and to the form of relief, should it be sought.2,3 The recommended management of chronic whiplash syndrome is patient education, exercises, reassurance, and a discouragement from litigation, all of which we should regard as appropriate. In my experience in medicolegal work with these patients, however, it is evident that some patients will come to their accident with an established pattern of illness behavior as a mode of life adjustment; in others, their management will have been effectively taken over by their solicitor, who will refer them to a variety of specialists in a quest for a detectable physical injury. The family practitioner is often powerless to influence this course of events and is, at best, only able to advise against unnecessary and inappropriate treatments of a surgical, multiple injection, analgesic, or other physical type.

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