Is Whiplash Real?

Just a few weeks ago, The Lancet published a study1 that was reported in all of the popular media as "proof" that whiplash is not a serious problem. Here is a review of a study that may create serious problems for those helping people with long-term whiplash pain.

The study contacted 202 Lithuanians who had been in a rear-end accident from 1 to 3 years earlier, and then had them answer questions about pain symptoms and headaches, without telling them why they were interested in this information. The researchers compared this group of patients to a group of age-matched controls. The authors conclude from their data that, "Our results suggest that chronic symptoms were not usually caused by the car accident. Expectation of disability, a family history, and attribution of preexisting symptoms to the trauma may be more important determinants for the evolution of the late whiplash syndrome."

This study raises a number of serious concerns:

  • The rate of whiplash has been calculated in western societies at 1 to 7 per 1,000 people. 2 This current study sent questionnaires to 240 accident subjects from a 3 year period in a city of 420,000 - a rate of .2 accidents per 1,000 people. This study does not make it clear whether all whiplash-type accident subjects were contacted, or whether they selectively picked them. If they picked all accidents that fit whiplash criteria, that would mean that rear-end accidents are far less common in Lithuania than they are here. This seems unlikely, as 17% of the control subjects had to be eliminated from the study because they had been in a previous accident.
  • Of the 202 accident subjects, 157 (77.7%) were men, even though the medical literature has repeatedly shown that women are more likely to suffer long-term effects from whiplash.
  • The researchers mailed out a total of 240 questionnaires, and 202 (84%) responded. The authors mention that they offered the participants entry into "a raffle for small prizes," but they don't mention what prizes these were. An 84% response rate seems very high for a survey sent out to the general public.
  • The study states that it used Lithuania as the country of choice because of the nearly complete absence of automobile insurance and lack of knowledge of whiplash injuries. Possible confounding factors not addressed in this study include: the cultural attitudes of pain in Lithuania; the effects of poverty (in 1993, the legal minimum wage in Lithuania was just US$6.78 - per month3); the quality, make, and accident protective factors of the cars; the quality of police reports in a country where insurance coverage is rare; and the ability of patients to recall preexisting conditions up to 3 years after an injury.

  1. Schrader H, Obelieniene D, Bovim G, et al. The Lancet 1996;347:1207-1211.
  2. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec task force on whiplash-associated disorders: Redefining 'whiplash' and its management. Spine 1995;20(suppl 8):1-73.
  3. The Statesman's Year-Book, Statistical and historical annual of the states of the world for the year 1995-1996, ed. Brian Hunter. St. Martin's Press, New York: p. 887.

 

 

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