There’s no good single treatment for the depression, pain, headaches, lack of sleep and other symptoms that nag many veterans of wars in Iraq, Afghanistan and elsewhere, experts said on Wednesday. But that doesn’t mean that the Department of Veterans Affairs shouldn’t take the complaints seriously and offer what help is available, from antidepressants to acupuncture and support groups, the Institute of Medicine panel said.
It recommends that the VA get a better grip on the problem, examining veterans as soon as they are discharged and keeping better records of their maladies. The VA should also actively look for veterans who are suffering and offer help.
The issue of whether “Gulf War Syndrome” even exists has been controversial almost since the first Gulf War began in 1991. Veterans complain they have been labeled as malingerers and denied treatment or compensation. Congress asked the Institute, one of the independent National Academies of Science, to examine the issue in 2010.
The report doesn’t offer any clear medical guidance, but it does call on the VA not only to act on complaints from veterans, but to reach out into the community to educate them about the syndrome. It’s no longer called Gulf War syndrome but chronic multisystem illness or CMI.
“Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation’s veterans,” the report reads.
“Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties) and may have comorbid syndromes with shared symptoms (such as chronic-fatigue syndrome, fibromyalgia, and irritable bowel syndrome) and other clinical entities (such as depression and anxiety).”
The panelists, who include experts in family medicine, alternative medicine, rehabilitation and chronic pain, reviewed other studies about the syndromes.
"Based on the voluminous evidence we reviewed, our committee cannot recommend using one universal therapy to manage the health of veterans with chronic multisymptom illness, and we reject a 'one size fits all' treatment approach," Dr. Bernard Rosof, who chaired the panel, said in a statement.
"Instead, we endorse individualized health care management plans as the best approach for treating this very real, highly diverse condition,” added Rosof, an expert in health care quality who heads the board of directors of Huntington Hospital in New York.
The report only partly satisfies Paul Sullivan of Austin, Texas, a 49-year-old Gulf War veteran. “That’s very good that the Institute of Medicine is suggesting that the VA take this issue seriously,” Sullivan said in a telephone interview. “VA has ignored the problems of Gulf War veterans for more than two decades.”
Sullivan who works doing veteran outreach at the law firm Bergmann & Moore, says he started suffering repeated respiratory infections, including bronchitis and pneumonia, when he returned from Iraq 22 years ago.“I came back with chronic respiratory problems and essentially, VA’s response had been to treat with antibiotics as needed,” he said. “It helps. But it doesn’t help me understand what causes it.”
Sullivan says he was exposed to many possible sources of damage to his lungs and breathing passages, including smoke from burning oil wells, pesticides and experimental drugs to counteract nerve agents. Thousands of veterans make the same complaints. “I was a healthy, fit person prior to joining the military, while in the military and while I was in the war zone,” Sullivan says.
The Institute of Medicine report is full of sympathy.
“About 700,000 military personnel served in the 1991 Gulf War, and as of September 2011, about 2.6 million military personnel have been deployed to the Iraq and Afghanistan wars. There is no script for the stresses that are endured; they are personal and many,” it reads.
“We hope that our recommendations will make a difference in the lives of people who have CMI. It is clear that this condition has adversely affected the health and well-being of a substantial number of our veterans and their families.”
The Department of Veterans Affairsshould put into place a long term, systemwide approach to managing the many different and varying symptoms of veterans with CMI, which include pain, respiratory and digestive ailments, the panel said. But it doesn’t have specific medical advice.
“CMI may benefit from such medications as selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and cognitive behavioral therapy,” it suggests. These are all treatments for depression but they have also been shown to help patients manage pain.
It also says VA needs to examine veterans as soon as they are discharged. “The Department of Veterans Affairs (VA) should commit the necessary resources to ensure that veterans complete a comprehensive health examination immediately upon separation from active duty,” the report advises.
“The results should become part of a veteran’s health record and should be made available to every clinician caring for the veteran, whether in or outside the VA health care system. Coordination of care, focused on transition in care, is essential for all veterans to ensure quality, patient safety, and the best health outcomes. “
The report calls for “CMI champions” at each VA medical center who would help coordinate care. Civilian doctors should be included when they want to be, the report adds.
And it says the VA should pay for better studies. “The Department of Veterans Affairs should fund and conduct studies of interventions that evidence suggests may hold promise for treatment of CMI. Specific interventions could include biofeedback, acupuncture, St. John’s wort, aerobic exercise, motivational interviewing, and multimodal therapies,” the report says.