ATLANTA—In every war in which the United States has participated, returning veterans have experienced a similar cluster of symptoms.1 This cluster has had different names through time—Soldier’s Heart, Effort Syndrome, Combat Stress Reaction, Agent Orange, and mild traumatic brain injury. Although studies have validated these symptom clusters to varying degrees, one thing the symptoms seem to have in common is their similarity to what fibromyalgia patients experience—pain, fatigue, and memory problems, according to Daniel J. Clauw, MD, professor of anesthesiology, medicine (rheumatology), and psychiatry and director of the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor.
Dr. Clauw discussed the common cluster of symptoms experienced by veterans of the first Gulf War during the ACR/ARHP 2010 Scientific Meeting session, “Musculoskeletal Pain and Returning Military Personnel.” [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Military Mystery
Although there were relatively few casualties among the 700,000 U.S. troops sent to the Gulf in the early 1990s, many experienced similar symptoms upon their return. “There were many soldiers complaining of joint and muscle pain, headaches, fatigue, difficulties with memory, rash, and gastrointestinal disturbances,” Dr. Clauw said. However, “their medical evaluations were generally unremarkable.”
The government spent millions of dollars researching the symptom cluster but could not pinpoint a specific illness. This situation led veterans’ groups to become distrustful of the U.S. government’s response to Gulf War veterans’ symptoms, Dr. Clauw explained. Now, many years later, after a number of Institute of Medicine and congressional panels—many of which Dr. Clauw took part or testified in—he said that a few things are clear. “The symptoms that Gulf War vets suffer are the exact same cluster of symptoms that occur in the general population and go by names such as fibromyalgia, chronic fatigue syndrome, and somatoform disorders,” he noted.
Although one study implicated vaccines given at the time of deployment that may have led to the constellation of symptoms, there have otherwise been no specific exposures that seem to have led to this condition in veterans, Dr. Clauw said. At the same time, “it’s very clear these symptoms were more common in deployed vets than nondeployed vets,” he said.
When we send people to war, they come back with pain, fatigue, and other symptoms. We need to do a better job of understanding the underlying pathogenesis.
In 1998, the Centers for Disease Control and Prevention coined the term “chronic multisymptom illnesses” to describe what these veterans were experiencing.2 The study authors defined someone as experiencing the illness if they had one or more chronic symptoms in at least two of three categories—fatigue, mood/cognition, and musculoskeletal.
