Drs. Littlejohn and Guymer reply.

Abstract

To the Editor: We thank Dr. Kapur for the comments1 on our recent editorial2. Many patients who have minor injuries in motor vehicle accidents can progress to develop significant and persistent pain. Often these patients fulfill criteria for fibromyalgia (FM), which is the most common chronic pain phenotype3. The presence of psychological distress occurring in this context is the key to subsequent development of chronic musculoskeletal pain4,5. In these situations, it is important to “get the diagnosis right” because FM is associated with central pain while whiplash implies ongoing peripheral nociceptive pain. The term “whiplash” is an emotive term because it implies that the neck has been forcefully traumatized by the motor vehicle accident, thus implying ongoing injury. The term “fibromyalgia” is descriptive and defined by robust clinical criteria3,6. The central pain of FM has its origins in changes in control … Address correspondence to Dr. Littlejohn, Suite H, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia. E-mail: Geoff.littlejohn{at}monash.edu