Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

Abstract

BackgroundChronic 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.MethodsData 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).ResultsChronic 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).ConclusionsThe 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.

Irritable bowel, chronic widespread pain, chronic fatigue and related syndromes are prevalent and highly overlapping in the general population: DanFunD

“…Our results on case characteristics are in line with several other studies on specific FSS It is a consistent finding that the female sex dominates in both IBS [10][11][12][13]49 , FM 5,14,16,50 , CFS 17,19,51 , WAD 52 , and MCS 22,23 . However, one study did not find any pronounced predominance of the female sex in FM 53 .…”

“…In the current study, all FSS are highly associated with self-rated poor quality of life, i.e. having a poor health or limitations in daily activities, which is similar to findings in other studies on IBS 6,[10][11][12][13]49 , FM 16,50 , CFS 17,51 , WAD 52,54,55 , and MCS 23 .…”

“…Other studies also found high comorbidity with other diseases in all FSS. This counts for both physical 5,6,14,18,22,50,52,54,56,57 and mental disease 5,10,14,[17][18][19][21][22][23][50][51][52]54,58,59 as well as other FSS 6,17,21,29,51,54,56,58,59 .…”

The central sensitization inventory: A user’s manual

“…The development of CS, and associated symptoms, is often related to trauma. CS is most often associated with physical trauma/injury (McBeth, Harkness, Silman, & MacFarlane, ; Myrtveit, Skogen, Wenzel, & Mykletun, ; Wenzel, Mykletun, & Nilsen, ), but can it also result from other types of trauma, such as certain infections (e.g., Hepatitis C, Epstein Barr, Lime Disease) and emotional trauma, including childhood abuse (Häuser, Kosseva, Üceyler, Klose, & Sommer, ; Kindler, Jones, Perrin, & Bennett, ; Phillips & Clauw, ; Wilson, ; Yunus, ). Spinal injuries to the low back (Sanzarello et al., ; Bid, Soni, & Rathod, ) and neck (Van Oosterwijck, Nijs, Meeus, & Paul, ) appear to be especially susceptible to developing CS symptoms, including chronic widespread pain (Kindler et al., ; McBeth et al., ; Myrtveit et al., ; Wenzel et al., ) and fibromyalgia (Buskila & Mader, ; Buskila, Neumann, Vaisberg, Alkalay, & Wolfe, ; Waylonis & Perkins, ).…”

Physical activity is independently associated with reduced mortality: 15-years follow-up of the Hordaland Health Study (HUSK)

“…As in previous studies [27], the total number of diagnoses were captured in one variable with three categories; “zero diagnoses” , “one diagnosis” , and “two or more diagnoses” .…”