Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline

Robbins, RC; Helmer, Drew A.; Monahan, Patrick B; Hunt, Stephen C.; McAndrew, Lisa M.; Nazario, Mitchell; Brown, William J.; Chao, Wendy; Navarro, Aniceto; Sall, James

doi:10.1016/j.mayocp.2022.01.031

Cited by 8 publications

(7 citation statements)

References 34 publications

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Section: Discussionmentioning

confidence: 99%

“…74,75 The guidelines endorse a holistic approach that includes conducting psychosocial assessments, maximizing non-pharmacologic therapies, and engaging in shared decisionmaking with veterans. 74,75…”

Section: Discussionmentioning

confidence: 99%

“…The most recent version of the Clinical Practice Guideline for managing veterans with GWI, issued by the VA and Department of Defense, incorporates this potential for therapeutic crossover in its recommendations 74,75 . The guidelines endorse a holistic approach that includes conducting psychosocial assessments, maximizing non‐pharmacologic therapies, and engaging in shared decision‐making with veterans 74,75 . In doing so, not only can we create evidence‐based treatment plans that are individualized to each veteran, but we may also avoid the potential overuse of diagnostic testing as suggested by our results above.…”

Section: Discussionmentioning

confidence: 99%

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Self‐reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

Malhotra

Boyle

Gifford

et al. 2023

Neurogastroenterology Motil

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Background: Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans.Methods: Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI−, GWI+/PTSD−, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Self‐reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

Malhotra

Boyle

Gifford

et al. 2023

Neurogastroenterology Motil

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“…1,2 As many as 30% of military veterans of the Persian Gulf War (1990War ( -1991 developed chronic disabling symptoms, collectively referred to as chronic multisymptom illness or Gulf War illness (GWI). [1][2][3] The 2021 Clinical Practice Guidelines for the Management of Chronic Multisymptom Illness recommend cognitive behavioral treatment [4][5][6] based on a clinical trial among veterans with GWI and indirect evidence from multiple trials for related conditions. 7 More direct evidence is needed to support the efficacy of behavioral treatments that target mechanisms relevant for GWI and are acceptable to veterans.…”

Section: Introductionmentioning

confidence: 99%

“…7 More direct evidence is needed to support the efficacy of behavioral treatments that target mechanisms relevant for GWI and are acceptable to veterans. 4,8,9 Developing acceptable treatments for GWI is critical because nonspecific treatments may not be acceptable to veterans who fought to legitimize GWI. 10,11 One factor known to maintain the disability of GWI is impairment in problem-solving ability, an executive function defined as the ability to find solutions to problems without an easily identified solution.…”

Section: Introductionmentioning

confidence: 99%

Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness

McAndrew

Quigley

et al. 2022

JAMA Netw Open

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ImportanceFew evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.ObjectiveTo examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.Design, Setting, and ParticipantsThis multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020.InterventionsProblem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks.Main Outcomes and MeasuresThe primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue.ResultsA total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education.Conclusions and RelevanceIn this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies.Trial RegistrationClinicalTrials.gov Identifier: NCT02161133

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Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder

Boyle,

Upchurch,

Gifford

et al. 2023

Journal of Traumatic Stress

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Gulf War illness (GWI) is a chronic multisymptom disorder of unknown etiology that is believed to be caused by neurotoxicant exposure experienced during deployment to the Gulf War. Posttraumatic stress disorder (PTSD) covaries with GWI and is believed to play a role in GWI symptoms. The present study examined the association between self‐reported military exposures and GWI, stratified by PTSD status, in veterans from the Gulf War Era Cohort and Biorepository who were deployed to the Persian Gulf during the war. Participants self‐reported current GWI and PTSD symptoms as well as military exposures (e.g., pyridostigmine [PB] pills, pesticides/insecticides, combat, chemical attacks, and oil well fires) experienced during the Gulf War. Deployed veterans’ (N = 921) GWI status was ascertained using the Centers for Disease Control and Prevention definition. Individuals who met the GWI criteria were stratified by PTSD status, yielding three groups: GWI‐, GWI+/PTSD‐, and GWI+/PTSD+. Multivariable logistic regression, adjusted for covariates, was used to examine associations between GWI/PTSD groups and military exposures. Apart from insect bait use, the GWI+/PTSD+ group had higher odds of reporting military exposures than the GWI+/PTSD‐ group, adjusted odds ratio (aOR) = 2.15, 95% CI [1.30, 3.56]–aOR = 6.91, 95% CI [3.39, 14.08]. Except for PB pills, the GWI+/PTSD‐ group had a higher likelihood of reporting military exposures than the GWI‐ group, aOR = 2.03, 95% CI [1.26, 3.26]–aOR = 4.01, 95% CI [1.57, 10.25]. These findings are consistent with roles for both PTSD and military exposures in the etiology of GWI.

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Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline

Cited by 8 publications

References 34 publications

Self‐reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

Self‐reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness

Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder

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