2002

Mild traumatic head injury, with or without direct impact to the head, is a possible consequence of an acceleration-deceleration mechanism of injury (whiplash).[1] Patients may present without a history of significant loss of consciousness and may not demonstrate any short-duration superficial loss of consciousness.

Despite the new evidence about the mechanics of whiplash and the overriding social and legal implications of whiplash, physicians still are called upon to offer practical self-help advice to their patients on what they can or cannot do. The consensus on whiplash management is currently settling upon a combination of therapeutic approaches, which include patient information, reassurance, and mobilization or activation through neck-specific exercises. This approach has not been scientifically validated, but is a synthesis of the best current evidence.

What is post-traumatic stress disorder?

Two decades of research have made it clear that physicians must distinguish pain from physical impairment, and differentiate illness behavior from disability. Also important is the distinction between disability and physical impairment as a consequence of physical pathology. The contribution of psychological, social, and behavioral factors to disability ranges from minimal to major.

I read with interest the article by Dr Montemuro on treatments for menopausal symptoms [BCMJ 2001;43(8):452-457], but I cannot agree with her assessment of the evidence in favor of the clinical use of St. John’s wort, black cohosh, ginkgo, or valerian.