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[Chronic whiplash syndrome--an overview].

In some countries a seemingly large number of patients suffer from chronic whiplash syndrome, whereas in other countries whiplash is not known or is considered to give only moderate symptoms over a brief period of time. In this paper, this discrepancy is accounted for by a biopsychosocial model, a central element of which is the existence of a large pool of spontaneously occurring symptoms in the population, among them head and neck pain. By the mechanisms of attribution, expectation ("nocebo") and reinforcement, common symptoms may be experienced by the patient as caused exclusively by a mild or moderate trauma. Inappropriate behaviour and harmful treatment may worsen and prolong symptoms. To this one should add the effects of conscious exaggeration of symptoms, under-performance in neuropsychological testing, and underreporting of pre-accident symptoms in a medico-legal context. When assessing litigation claims, it is emphasised that a causal relation between common whiplash injuries and chronic complaints has not been demonstrated; a causal relationship can be accepted in exceptional cases only if a set of minimal criteria are fulfilled.