Whiplash cultures
=================

* Robert Ferrari

The recent CMAJ piece on the increase in the cost of seat-belt-related injuries [1] reveals the seriousness of the whiplash problem in the United Kingdom. It is a medicolegal and social problem in many other countries as well.

There is a stark contrast, however, between the experience of whiplash in areas such as the United Kingdom and North America and that in Lithuania, Greece and Germany. In the latter countries, acute whiplash injury does occur frequently, but despite the use of seat belts, whiplash patients do not appear to have an increased risk of chronic pain compared with the uninjured population. [2] The acute whiplash injury is not even associated, in most cases, with short-term disability; time off work (if any) is usually 2 weeks or less. This is despite the fact that in both Greece and Germany, for example, accident victims have full insurance and disability coverage and are fully entitled to and do (especially in Germany) engage in litigation if they so desire. Yet in these same countries, recovery routinely occurs in 6 weeks or less, and treatment costs are usually less than Can$100-200. It has been shown that this profoundly different outcome is not due to a failure to report symptoms or cultural stoicism. [2]

The reasons for these cross-cultural differences are many and complex, but their elucidation is the basis for new paradigms for the management of this problem in "whiplash cultures." [3] The problem may not be, as Charles Galasko suggests, a lack of attention to whiplash in countries where it is epidemic, [1] but rather our lack of attention to whiplash in countries in which it is not.

Robert Ferrari, MD

Edmonton, Alta.

## References

1.  1. LeBourdais E. Cost of seat-belt-related whiplash injuries rising. CMAJ1999;160(10):1425.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6MzoiUERGIjtzOjExOiJqb3VybmFsQ29kZSI7czo0OiJjbWFqIjtzOjU6InJlc2lkIjtzOjExOiIxNjAvMTAvMTQyNSI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xNjEvNC8zNjguMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Obelieniene D, Schrader H, Bovim G, Miseviciene I, Sand T. Pain after whiplash - a prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry1999;66:279-83.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiam5ucCI7czo1OiJyZXNpZCI7czo4OiI2Ni8zLzI3OSI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xNjEvNC8zNjguMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  3. Ferrari R, Kwan O, Russell AS, Schrader H, Pearce JMS. The best approach to the problem of whiplash? One ticket to Lithuania, please. Clin Exp Rheumatol1999;17:321-6.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10410265&link_type=MED&atom=%2Fcmaj%2F161%2F4%2F368.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000080500500008&link_type=ISI)