Faculty of medicine and dentistry, University of Bergen (UoB), Bergen, Norway
BMC Psychiatry. 2012 Aug 31;12:129. doi: 10.1186/1471-244X-12-129.
Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study.
Data from the Norwegian population-based "Hordaland Health Study" (HUSK, 1997-99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45).
Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032).
The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.
慢性颈痛会导致患者承受极大的痛苦和社会资源的大量消耗。慢性颈痛的病因有两种相互竞争的假说。传统的器质性假说认为慢性颈痛及其相关症状是特定损伤的结果。相反，假说认为慢性颈痛是一种功能性躯体综合征，相关症状是社会诱导的预期和症状放大的结果。根据这两种假说，报告患有慢性颈痛的患者比一般人群更容易出现颈部疼痛、头痛以及焦虑和抑郁症状。对于超出与颈痛相关的躯体症状的患病率，研究较少。本研究的目的是检验功能假说的一个推论：在报告慢性颈痛的个体中，除了与颈痛损伤直接相关的症状外，是否存在躯体化障碍中所见的躯体症状患病率增加？我们还旨在通过比较报告慢性颈痛的个体和报告非功能性损伤（手部或腕部骨折）的个体的症状特征，来探讨回忆偏倚。我们探讨了症状负荷，病因在本研究中无法调查。
我们使用了挪威基于人群的“霍达兰健康研究”（HUSK，1997-99 年）的数据；N=13986。403 名个体报告了慢性颈痛，1746 名个体报告了手部或腕部骨折。躯体化倾向使用从躯体化障碍的研究标准（ICD-10，F45）中衍生的 17 种来自不同身体部位和器官系统的躯体症状列表进行测量。
慢性颈痛与所有 17 种研究的躯体症状水平升高有关（p<0.05）。这种关联具有中等强度（组间差异为 0.60 标准差），部分归因于混杂因素。对于手部或腕部骨折，症状仅略有升高。近期颈痛比很久以前的颈痛损伤更常见，而我们感兴趣的关联随着颈痛时间的推移而略有增加（r=0.016，p=0.032）。
慢性颈痛的躯体症状患病率增加，超出了慢性颈痛器质性损伤模型所预期的症状，这对颈痛的标准损伤模型提出了挑战，并且表明慢性颈痛是一种功能性躯体综合征。
