More than 90 per cent of patients with whiplash attending a Dublin pain management clinic failed to return for additional treatment once their legal action was completed. Neurosurgeon Jack Phillips, when asked by the Irish Times whether whiplash was a real phenomenon, responded “it is both fact and fiction; the original injury is factual but there is a fictitious element that leads to chronic presentations”.

"Perfect storm"

The unpublished finding reported by the Irish Times, from a study of 100 patients of the Mater Hospital pain management service, is quoted in a paper by two leading neurosurgeons as evidence Ireland is experiencing “a whiplash epidemic” requiring urgent reform. Dr Phillips and Ciarán Bolger, neurosurgeons at Beaumont Hospital in Dublin, describe whiplash as a “concept” surrounded by “myths” not based on scientific evidence. The doctors point out that people who suffer whiplash injuries in sport - or who do not take legal action - recover in six to 12 weeks, and are advised to “act as usual and return to play.” This contrasts with people taking cases over whiplash injuries, who suffer a “perfect storm” due to protracted litigation that can last years. Advised to rest, they are prescribed opiates and other pain medicines and may suffer early post-traumatic stress disorder. The doctors say such patients are at risk of addiction, early post-traumatic stress disorder, “misinterpreted” MRIs and repeated pain-management treatment with no designated end-point. As a result, they say, litigants may lose their jobs, suffer family distress and become addicted to opiates The findings were presented at the European Association of Neurosurgical Societies conference in Dublin, where delegates also noted whiplash was far less prevalent in the European countries where they practised.

Culturally dependent

Describing litigants as “victims”, Dr Phillips said the evidence “points to an alleged injury syndrome which is present in Western societies with a culture of legal action”. The two doctors explained the outcome of whiplash injury is “culturally dependent”, with few lasting symptoms in countries such Germany, Greece or Lithuania where compensation is not generally available. The doctors also question the evidence offered, where the engineering reports prepared for court cases frequently question the severity of symptoms following whiplash injuries, “particularly where accidents occur at roundabout with slowing speeds varying between 5-10km an hour”. The also suggested, “Equally mystifying is the absence of injury to the rear-ending driver, despite the impact of equal and opposite forces.” Referring to Canadian research, the two doctors suggest the many symptoms and psychological factors linked to whiplash suggest “a systemic illness behaviour … determined less by the etiology (cause) of the injury and more globally by an environment that encouraged a recognisable illness behaviour which evolved regardless of the initial pathology”. They also cited a study of the patients of a Galway spinal surgeon, which found only 10 out of 301 were seen in his clinic after their litigation had finished.