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The late whiplash syndrome: a biopsychosocial approach
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    In their admirable review, Ferrari and Schrader1 re-introduce2 the biopsychosocial model which recognises that the late whiplash syndrome is not the result of a chronic injury. They note the influence of compensation incentives such as that seen in Switzerland and other western countries. It is the high percentage of patients with chronic pain attributed to accidents that provide the greatest health care and economic burden,

    The biopsychosocial model considers an effect of cultural expectation, cultural factors that generate symptom amplification and attribution. I agree with their conclusion that it negates the concept of “chronic injury”,3 but at the same time takes away the stigmata of the psychiatric label, while explaining that people's behaviour in response to their injury may generate much of the illness. The authors surprisingly neglect the final mechanism of the symptoms so often claimed in medicolegal practice, but so seldom encountered in the hospital clinic. They seem to blame cultural expectations and society at large, but they fail to consider the “victim”, who stands to gain sums of money, often larger …

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