The best approach to the problem of whiplash ? One ticket to Lithuania, please

R. Ferrari, O. Kwan, A.S. Russell¹, J.M.S. Pearce², H. Schrader³

¹Department of Rheumatic Diseases, University of Alberta, Edmonton, Alberta, Canada; ²Hull Royal Infirmary, Hull, United Kingdom; ³Norwegian University of Science and Technology, Faculty of Medicine, Department of Neurology, University Hospital, Trondheim, Norway.

ABSTRACT
The Quebec Task Force (QTF) on Whiplash Associated Disorders (WAD) - 1995 - sent a clear message that we need to re-evaluate the basis for our treatment strategies, and in particular place more emphasis on research to better define these strategies. Judging by many of the clinical strategies currently in use, the Task Force recommendations seem to have been largely ignored three years later. A further compelling reason to re-evaluate our current practices at this time is the finding of much more rapid recovery rates in some cultures, even with little or no therapy. This commentary is a frank consideration of the therapeutic community’s responsibility to not only help solve the dilemma of whiplash, but also avoid contributing to the problem. We thus explore a new biopsychosocial model of whiplash, considering the effects of symptom expectation, amplification, and attribution in chronic pain reporting. Based on that model we propose a treatment strategy, and conclude that such strategies provide the only viable approach to this medicolegal and social dilemma.

Key words
Whiplash, neck pain, neck sprain, traffic accidents, epidemiology, physical therapy, exercise therapy.

Please address correspondence and reprint requests to: Dr. Robert Ferrari, 12779 - 50 Street, Edmonton, Alberta, Canada T5A 4L8.

Clin Exp Rheumatol 1999; 17: 321-326.
© Copyright Clinical and Experimental Rheumatology 1999.