Regarding Mayou & Bryant's study (Reference Mayou and Bryant2002), it is interesting that the predictors of pain at 1 year are ‘feeling not to blame for the accident’, claiming compensation and ‘anger cognitions’. With multivariate analysis, only claiming compensation at 3 months is a predictor of pain at 1 year. This means that feeling not to blame for the accident, initial anger or anger cognitions are predictors of pain only in claimants, otherwise not. Thus, of two patients, both not-at-fault, and both equally angry, it is the one who chooses litigation that will have the worse outcome. Why?

Does litigation/claims create a psychosomatic phenomenon that allows anger and victimisation to express itself as pain? Or are litigants more likely to be compelled to focus on all sources of aches and pains in their life (even pre-accident sources) by keeping pain diaries more often and by being instructed to see more physicians and therapists, to withdraw from more activities that hurt, to take more medications, to develop poor physical fitness, postural problems, medication adverse effects and anxiety?

It is further interesting that 14% of accident victims with no injury had bodily pain at 3 months! How does this happen? Is it a manifestation of psychological distress, or perhaps does pain occur as part of life, even if not injured (or, for that matter, even if not involved in an accident)? The percentage of accident victims with pain at 1 year in the ‘no injury’ group is half that of whiplash injury victims with pain at 1 year (27%). As one does not expect whiplash injury to create an immunity from whatever is affecting the ‘no injury group’, half of the whiplash injury group was going to have pain at 1 year, even if they had had no injury, or had fully recovered from their injury, because the ‘no injury’ group gets pain anyway. Not all of the pain at 1 year in whiplash victims can thus be due to physical effects of the initial injury, since then there would be at least some additional burden of pain from whatever factors also cause pain in the ‘no injury’ group as well. Statistically, half of the chronic pain that exists in whiplash patients is independent of having had an initial physical injury.

The findings of this study also suggest that when a physician encounters a patient who is not to blame for an accident and who is feeling angry, the physician should very clearly advise that entering a claim will adversely affect the patient's health and is more likely to lead to chronic pain.