The validity of whiplash syndrome has been a source of debate in the medical literature for many years. Some authors have published articles suggesting that whiplash injuries are impossible at certain collision speeds; others have stated that the problem is psychological, or is feigned as a means to obtain secondary financial gain. These articles contradict the majority of the literature, which shows that whiplash injuries and their sequelae are a highly prevalent problem that affects a significant proportion of the population. The authors of the current literature critique reviewed the biomedical and engineering literature relating to whiplash syndrome, searching for articles that refuted the validity of whiplash injuries. Twenty articles containing nine distinct statements refuting the validity of whiplash syndrome were found that fit the inclusion criteria. The methodology described in these articles was evaluated critically to determine if the authors' observations regarding the validity of whiplash syndrome were scientifically sound. The authors of the current critique found that all of the articles contained significant methodologic flaws with regard to their respective authors' statements refuting the validity of whiplash syndrome. The most frequently found flaws were inadequate study size, nonrepresentative study sample, nonrepresentative crash conditions (for crash tests), and inappropriate study design. As a result of the current literature review, it was determined that there is no epidemiologic or scientific basis in the literature for the following statements: whiplash injuries do not lead to chronic pain, rear impact collisions that do not result in vehicle damage are unlikely to cause injury, and whiplash trauma is biomechanically comparable with common movements of daily living.

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The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further.

MD Freeman, AC Croft, AM Rossignol, CJ Centeno, WL Elkins. Chronic neck pain and whiplash: A case-control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Res Manage 2006;11(2):79-83.The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain. Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.Key Words: Case-control study; Chronic neck pain; Motor vehicle crash; Whiplash Douleur cervicale chronique et coup de fouet cervical : Étude cas-témoins du rapport entre coup de fouet cervical aigu et douleur cervicale chroniqueLes auteurs ont entrepris une étude cas-témoins sur la douleur cervicale chronique et le coup de fouet cervical dans neuf états des États-Unis afin de déterminer si le coup de fouet cervical contribuait de façon significative au problème de douleur cervicale ou d'autres dorsalgies chroniques chez une population de patients ainsi affligés. Quatre cent dix-neuf patients et deux cent quarante-six témoins ont été randomisés dans le cadre de l'étude. Les patients étaient des personnes souffrant de douleur cervicale chronique et les témoins, des personnes souffrant de dorsalgie chronique. Les deux groupes ont été interrogés sur la cause de leurs douleurs chroniques et sur leurs caractéristiques démo-graphiques. Les deux groupes ont été comparés quant à leur risque relatif approché d'exposition. Quarante-cinq pour cent des patients ont relié leur douleur à un accident de la route. Des RR de 4,0 et de 2,1 ont été calculés pour les hommes et les femmes, respectivement. Sur la base des résultats de la présente étude, il serait raisonnable de supposer qu'un accident de la route soit à l'origine de la douleur cervicale chronique chez une proportion importante de patients atteints dans la population générale.

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