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Controversies in Neurology
April 2000


Author Affiliations


Arch Neurol. 2000;57(4):594. doi:10.1001/archneur.57.4.594

FEW CONDITIONS rouse emotions as quickly as a discussion of whiplash, and yet plausible explanations for the phenomenon are slowly beginning to emerge.

Bogduk and Teasell point out that after acute injury most patients recover rapidly, 80% being asymptomatic by 1 year, 15% to 20% remaining symptomatic, 5% severely so. This is in keeping with Berry's observation that drivers of demolition derbies seldom experience chronic symptoms or disability, despite thousands of collisions. The contributors differ in their explanations for chronic symptoms. Bogduk and Teasell state that those with chronic symptoms are likely to have a substantive injury, whereas Berry points out that too often a simplistic physical explanation is sought for this multifaceted condition. Bogduk and Teasell refer to a study in which psychological distress was relieved when the pain was. If the pain recurred, the psychological distress reappeared, but if the pain was removed, once again the psychological distress did likewise. This shows that psychological distress follows physical distress but does not explain the full repertoire of whiplash manifestations. Berry notes that "clinical practitioners approach the patient with the particular conceptual orientation of their specialties," and that multiple consultations in these patients result in a "starburst" of diagnoses. He points out that little attention is paid to the role of illness as an adjustment to life and that "marginal, tentative, or hypothesized physical changes are taken to be convincing, and obvious emotional and behavioral evidence is ignored."

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