{'fraction_non_alphanumeric': 0.018395503321410323, 'fraction_numerical': 0.006642820643842616, 'mean_word_length': 5.04320987654321, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Handicap after acute whiplash injury

To the Editor:

Chronic pain is a common component of traumatic injuries. There are acceleration and deceleration forces, specifically in whiplash, that produce a strain and sprain of the soft tissues in the neck inducing localized pain. Kasch et al.1 noted that the cervical range-of-motion test was a good predictor of late sequelae of chronic pain and disability in Denmark. They did not feel that litigation influenced recovery. Their experience is significantly different from that reported in the literature, as well as the experience in the United States; therefore, his conclusions are unique only to Denmark and not generalizable. For example, Balla2 compared chronic pain from vehicular accidents in Australia and Singapore and noted that the “late whiplash syndrome” does not exist in Singapore! He attributed this not only to culture but also lack of density of lawyers and insurance industry. A similar observation was reported from Lithuania, where most drivers have no insurance for personal injury and there is no expectation of symptoms or disability. There is also minimal representation of the legal and insurance system. Neck pain usually disappeared after 20 days and was not present after 1 year.3 Tort reform in the Canadian province of Saskatchewan, where a no-fault system was introduced, led to a significant reduction of claims for chronic pain.4

In the United States, the insurance and legal systems are unique not only because of sophistication but also because of the sheer density of 750,000 lawyers. Compensation and no-fault systems exist to protect individuals who are injured. Although most patients have sustained legitimate injuries and have legitimate complaints, some claims are fraudulent. Pain is subjective and expectations of financial rewards in some patients appear to exploit vague and subjective symptoms for primary and secondary gain. It remains to be established how …