There was a very interesting review on whiplash in JRSM back in October (Livingston M, J R Soc Med 20000;93:526-9).
Among other very sensible conclusions, the element of psychosocial influence was emphasised. An example was given of a Greek study of 130 consecutive patients with whiplash-associated disorder uncomplicated by # or neurological damage, who received minimal or no therapy. 91% were symptomless four weeks later.
He quotes "perhaps by not receiving (and then failing to respond to) multiple therapies, no anxiety is created. Patients do not change their activities to any extent, or stop work, and will not develop poor posture or poor physical fitness... in other countries however, the media and medical community attention to whiplash enforces the notion that it causes chronic pain."
No, it wasn't an RCT but it was very interesting!
Giles Cattermole, SpR.
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