Huisarts en Wetenschap

, Volume 47, Issue 1, pp 1000–1004 | Cite as

Het chronische-whiplashsyndroom: oplosbaar of niet?

  • F Kovács
  • ML van Harten


Kovács F, Van Harten ML. Het chronische-whiplashsyndroom: oplosbaar of niet? Huisarts Wet 2004;47(1):38-41.

Het chronische-whiplashsyndroom is controversieel. Bij whiplashklachten moet allereerst een onderscheid worden gemaakt tussen een acuut en een chronisch klachtenbeloop. Ten tweede wordt duidelijk gemaakt dat de aanname van (licht) hersenletsel bij dit syndroom voornamelijk gebaseerd is op het onderpresteren op neuropsychologische tests. Een dergelijke aanname is niet alleen onjuist, maar staat tevens een effectieve behandeling van chronische whiplashpatiënten in de weg. Ten derde is er een opvallende gelijkenis tussen het chronische-whiplashsyndroom en het chronische-pijnsyndroom. Uitgaande van het biopsychosociale model zijn er enige effectieve behandelingen ontwikkeld waarbij het vooral gaat om de copingvaardigheden van de chronische- whiplashpatiënt. Tot slot geven wij enige praktische adviezen bij de behandeling van deze patiënten.

beschouwing bewegingsapparaat cognitieve gedragstherapie patiëntengedrag pijn whiplash 


Kovács F, Van Harten ML. Chronic whiplash syndrome: solvable or not?

Huisarts Wet 2004;47(1):38-41.

This article presents several issues concerning the highly controversial syndrome known as Whiplash Associated Disorder (WAD). First of all we argue that a distinction must be made between an acute and a chronic phase of the syndrome. Secondly, we show that the assumption that (mild) brain damage is related to WAD is highly unlikely and that such a conclusion can seriously hinder appropriate treatment of the complaints.

Thirdly, we state that WAD closely resembles chronic pain syndrome.

On the basis of the so-called biopsychosocial model several treatments have been developed which focus on the coping style of WAD patients. The article ends by proposing several practice guidelines for the treatment of chronic WAD patients by the GP.


  1. Cassidy JD, editor. Scientific monograph of the Quebec Task Force on Whiplash Associated Disorders. Redefining whiplash and its management. Spine 1995;20:9-73.Google Scholar
  2. Gargan MF, Bannister GC. The rate of recovery following whiplash injury. Eur Spine J 1994;3:162-4.CrossRefPubMedGoogle Scholar
  3. Kessels RPC. Neuropsychological consequences of whiplash injury following motor-vehicle collisions: an update. J Whiplash Relat Disord 2003 (in druk).Google Scholar
  4. Schmand B, Lindeboom J, Schagen S, Heijt R, Koene T, Hamburger HL. Cognitive complaints in patients after whiplash injury: the impact of malingering. J Neurol Neurosurg Psychiatry 1998;64:339-43.CrossRefPubMedGoogle Scholar
  5. Söderlund A, Lindberg P. Whiplash-associated disorders – predicting disability from a process-oriented perspective of coping. Clin Rehabil 2003;17:101-7.CrossRefPubMedGoogle Scholar
  6. Dijkstra S, Mesch H. Het post-whiplashsyndroom. Voor altijd genekt? De Psycholoog 1997;10:398-404.Google Scholar
  7. Vendrig AA, Van Akkerveeken PF, McWhorter KR. Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck. Spine 2000;25:238-44.CrossRefPubMedGoogle Scholar
  8. Vendrig AA, Hoofs MH, Van Akkerveeken PF, Lamberts-Hopkes KJ. Multidisciplinaire aanpak van chronische rugpijn: werkhervatting na 3-4 jaar hetzelfde als na 6 maanden. Ned Tijdschr Geneeskd 2000;144:2207-9.PubMedGoogle Scholar
  9. Fordyce WE, Fowler RS, Lehman JF, Delateur BJ, Sand PL, Trieschmann RB. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehabil 1973;54:399-408.PubMedGoogle Scholar
  10. Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. Pain 2000;84:65-75.CrossRefPubMedGoogle Scholar
  11. Livingstone WK. Pain mechanisms. New York: Plenum Press, 1976.Google Scholar
  12. Vlaeyen JWS, Crombez G. Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients. Man Ther 1999;4:187-95.CrossRefPubMedGoogle Scholar
  13. Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med 1999;130:910-21.PubMedGoogle Scholar
  14. Larsson SE, Alund M, Cai H, Ake Oberg P. Chronic pain after softtissue injury of the cervical spine: trapezius muscle blood flow and electromyography at static loads and fatigue. Pain 1994;57:173-80.CrossRefPubMedGoogle Scholar
  15. Highland TR, Dreisinger TE, Vie LL, Russell GS. Changes in isometric strength and range of motion of the isolated cervical spine after eight weeks of clinical rehabilitation. Spine 1992;17:77-82.CrossRefGoogle Scholar
  16. Akeson WH, Amiel D, Abel MF, Garfin SR, Woo SL. Effects of immobilization on joints. Clin Orthop 1987;219:28-37.PubMedGoogle Scholar
  17. Gamble JG, Edwards CC, Max SR. Enzymatic adaptation in ligaments during immobilization. Am J Sports Med 1984;12:221-8.CrossRefPubMedGoogle Scholar
  18. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84:191-215.CrossRefPubMedGoogle Scholar
  19. Petrovic P, Petersson KM, Ghatan S, Stone-Elander S, Ingvar M. Painrelated cerebral activation is altered by a distracting cognitive task. Pain 2000;85:19-30.CrossRefPubMedGoogle Scholar
  20. Arntz A, Hopmans M. Underpredicted pain disrupts more than correctly predicted pain, but does not hurt more. Behav Res Ther 1998;36:1121-9.CrossRefPubMedGoogle Scholar
  21. Klaver MM. Het whiplashsyndroom en zelfcontrole. Huisarts Wet 1998;41:613-6.Google Scholar
  22. Ferrari R, Schrader H. The late whiplash syndrome: a biopsychosocial approach. J Neurol Neurosurg Psychiatry 2001;70:722-6.CrossRefPubMedGoogle Scholar
  23. Prins JB, Bleijenberg G, Bazelmans E, Elving LD, De Boo TM, Severens JL, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet 2001;357:841-7.CrossRefPubMedGoogle Scholar
  24. McClune T, Burton AK, Waddell G. Whiplash associated disorders: a review of the literature to guide patient information and advice. Emerg Med J 2002;19:499-506.CrossRefPubMedGoogle Scholar
  25. Ferrari R. Prevention of chronic pain after whiplash. Emerg Med J 2002;19:526-30.CrossRefPubMedGoogle Scholar
  26. Cassidy JD, Carroll LJ, Cote P, Lemstra M, Berglund A, Nygren A. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 2000;342:1179-86.CrossRefPubMedGoogle Scholar
  27. Scholten-Peeters GG, Verhagen AP, Bekkering GE, Van der Windt DA, Barnsley, Oostendorp RA, et al. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies. Pain 2003;104:303-22.CrossRefPubMedGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2004

Authors and Affiliations

  1. 1.

Personalised recommendations