Cognitive Behavioral Therapy and Aerobic Exercise for Gulf War Veterans' Illnesses

Donta, Sam T.; Clauw, Daniel J.; Engel, Charles C.; Guarino, Peter; Peduzzi, Peter; Williams, David A.; Skinner, James S.; Barkhuizen, André; Taylor, Thomas N.; Kazis, Lewis E.; Sogg, Stephanie; Hunt, Stephen C.; Dougherty, Cynthia M.; Richardson, Ralph D.; Kunkel, Charles F.; Rodriguez, William; Alicea, Edwin; Chiliade, Philippe; Ryan, Margaret A. K.; Gray, Gregory C.; Lutwick, Larry I.; Norwood, Dorothy; Smith, Samantha; Everson, Michael P.; Blackburn, Warren D.; Martin, W. H.; Griffiss, J M; Cooper, Robert B.; Renner, Ed; Schmitt, James M.; McMurtry, C. Meghan; Thakore, Manisha; Mori, DeAnna L.; Kerns, Robert D.; Park, Maryann; Pullman-Mooar, Sally; Bernstein, J.; Hershberger, Paul J.; Salisbury, Don C; Feussner, John R.

doi:10.1001/jama.289.11.1396

Cited by 157 publications

(97 citation statements)

References 43 publications

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“…Drugs that affect central levels of neuromodulators known to be involved in pain processing (e.g., tricyclic antidepressants) are more effective in the management of centralized pain than are alternate classes of compounds that work well for peripheral pain (e.g., nonsteroidal antiinflammatory drugs or opioids) (63,65). Similarly, nonpharmacologic therapies, such as aerobic exercise and cognitive behavioral therapy (66), can be especially useful adjuncts to treating this constellation of chronic pain symptoms and syndromes.…”

Section: Augmented Pain Processing In Idiopathic Chronic Low Back Painmentioning

confidence: 99%

Evidence of augmented central pain processing in idiopathic chronic low back pain

Giesecke¹,

Gracely²,

Grant³

et al. 2004

Arthritis & Rheumatism

709

456

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Objective. For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n ‫؍‬ 11), patients with widespread pain (fibromyalgia; n ‫؍‬ 16), and healthy control subjects (n ‫؍‬ 11).Methods. Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site.Results. Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P ‫؍‬ 0.03) or the patients with fibromyalgia (3.5 kg) (P ‫؍‬ 0.006).When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups.Conclusion. At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP.Chronic low back pain (CLBP) is one of the most common and expensive musculoskeletal disorders in developed countries (1,2). Back pain in general affects 70-85% of all people at some time in their lives, but 90% of affected individuals recover, typically within 12 weeks (3). Recovery after 12 weeks is slow and uncertain, and this subset of patients with CLBP accounts for major expenses in the health care and disability systems (2,4).Despite the magnitude of the problem, little is known about the precise cause of CLBP. There is often a mismatch between objectiv...

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Section: Augmented Pain Processing In Idiopathic Chronic Low Back Painmentioning

confidence: 99%

Evidence of augmented central pain processing in idiopathic chronic low back pain

Giesecke¹,

Gracely²,

Grant³

et al. 2004

Arthritis & Rheumatism

709

456

View full text Add to dashboard Cite

show abstract

“…In addition, as interpretations of events have been shown to be amenable to intervention, cognitive-behavioral therapies might be able to improve veteran health and quality of life by reframing the threat or associated fear-provoking cognitions and placing them in a reasonable context that is more approachable and controllable and less overwhelming and intrusive in day-today behaviors and thoughts. Although few studies have focused on cognitive behavior applications to Gulf War veterans' physical health (see Donta and colleagues [54] for an exception), such interventions have been demonstrated to be effective adjunct therapies in other related populations, including those with fibromyalgia [55], chronic pain [56], headache, chronic fatigue syndrome, and tinnitus [57], and may prove useful in future treatment programs for veterans with physical health complaints that reflect potential Gulf War illnesses.…”

Section: Clinical Implications and Limitationsmentioning

confidence: 99%

Risk factors for mental, physical, and functional health in Gulf War veterans

King

King²,

Bolton³

et al. 2008

JRRD

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Abstract-Risk factors associated with war-zone events and circumstances are implicated in the health and adjustment of military veterans. We assessed a national stratified sample of community-residing veterans of the Gulf War (N = 357) using scales from the Deployment Risk and Resilience Inventory, along with an array of mental (posttraumatic stress disorder, depression, and anxiety), physical (symptom and condition indicators especially pertinent to Gulf War illnesses), and functional (both mental and physical dimensions) health outcomes. We found that perceived threat or fear of bodily harm in the war zone and self-reported or perceived exposures to environmental hazards may play a critical role in all measured aspects of health. Moreover, a synergistic effect of these two risk factors was observed in the prediction of mental health and mental health functional status.

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“…The trial involved 1092 symptomatic Gulf veterans. The interventions achieved little improvement in their symptoms (Donta et al, 2003).…”

Section: Have Treatments Been Successful?mentioning

confidence: 93%

Gulf War syndrome – has it gone away?

Tarn¹,

Greenberg²,

Wessely³

2008

Adv. psychiatr. treat

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‘Gulf War syndrome’ was a phrase coined after the 1991 Gulf War. This article looks at the variety of hypotheses that have been put forward about the origins of the concept and the studies attempting to characterise the health manifestations of Gulf service and the lasting effects on veterans. It also serves to bring readers up to date with research on the present deployment in Iraq. Finally, consideration is given to how Gulf War syndrome compares with the rich historical literature of post-conflict medical syndromes and how sociological factors may interact with symptom attribution in veterans.

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Cognitive Behavioral Therapy and Aerobic Exercise for Gulf War Veterans' Illnesses

Cited by 157 publications

References 43 publications

Evidence of augmented central pain processing in idiopathic chronic low back pain

Evidence of augmented central pain processing in idiopathic chronic low back pain

Risk factors for mental, physical, and functional health in Gulf War veterans

Gulf War syndrome – has it gone away?

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