title: 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: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of medicine and dentistry, University of Bergen (UoB), Bergen, Norway
authors.forename: Solbjørg Makalani
authors.initials: SM
authors.lastname: Myrtveit
authors.forename: Jens Christoffer
authors.initials: JC
authors.lastname: Skogen
authors.forename: Hanne Gro
authors.initials: HG
authors.lastname: Wenzel
authors.forename: Arnstein
authors.initials: A
authors.lastname: Mykletun
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D057566:Self Report; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014911:Whiplash Injuries / Q000150:complications / Q000453:epidemiology*