Psychological issues play a role in the whiplash syndrome—this is well recognized by both physicians and the medical literature. What is still a mystery is the exact relationship between psychological symptoms and pain, disability, and litigation. Most caregivers attribute emotional distress to chronic pain and the stress of litigation (or dealing with insurance companies); insurance companies claim that emotional symptoms are a sign of malingering. Where does the truth lie on this continuum?
A new British study provides some insight. The authors of this study followed 57 whiplash patients for one year. The study began when the patients presented at the emergency room for evaluation immediately after the accident. They were contacted at home soon after this visit, and the authors recorded: demographic data, nature of the accident, previous social adjustment, previous driving behavior, and psychological self-report information. Data were also collected from the emergency department and police reports.
These same patients were again interviewed at three months and at one year after the first evaluation. This interview covered the above topics, as well as current medical symptoms, post-traumatic psychological symptoms, changes in driving behavior, and litigation status. Those with pending litigation at 1 year were contacted again at 2 and 3 years to check on litigation status.
The findings were as follows:
The study found that at one year, 49% reported neck pain that they associated with the accident; in most cases these symptoms were mild, but they did interfere with daily activities in 8-25% of patients.
The authors also reported on two kinds of post-traumatic stress problems: post-traumatic stress syndrome (PTSD) in 10% of the patients; and travel anxiety in 19%. Travel anxiety manifested itself as "Limitation and avoidance of social and other activities as a result of travel anxiety, for example reduced excursions, week-ends away and visiting relatives and friends. Anxiety about situations similar to the accident and passing the place of the accident was frequent." The authors state that travel anxiety should be addressed with new patients after whiplash, and that any long-term symptoms may require referral to behavioral therapy to prevent a chronic problem.
Mayou R, Bryant B. Outcome of 'whiplash' neck injury. Injury 1996;27(9):617-623.