For years, doctors have been unable to recommend effective treatments for the chronic fatigue, pain, mental fuzziness and psychological distress among U.S. and European troops dispatched to the Persian Gulf in 1990-91. That's finally changing, even as a new generation of soldiers heads to the region.
Researchers have found that cognitive behavioral therapy can modestly improve the physical functioning of ill veterans, while exercise can relieve some of their fatigue and other symptoms.
However, neither treatment alleviates the pain associated with what's come to be called Gulf War syndrome, according to a study in the current issue of the Journal of the American Medical Assn.
The findings have prompted the Department of Veterans Affairs to begin recommending these therapies for ill Gulf War veterans, said Dr. Kelley Brix, the department's assistant chief of research and development.
"We're planning to disseminate this information to about 200 physicians around the country that see a lot of Gulf War veterans in their clinics."
The study represents "the first credible trial of an intervention for symptomatic Gulf War veterans," wrote Matthew Hotopf, a Gulf War illness researcher at King's College, London, in an accompanying editorial.
No one has ever clearly defined Gulf War syndrome, much less identified a cause for the clusters of symptoms that plague thousands of Gulf War veterans. But the latest approach to treatment stems from the recognition that veterans' symptoms resemble those of patients with chronic fatigue syndrome or fibromyalgia -- and that both those conditions respond to exercise and cognitive behavioral therapy.
Researchers at 20 veterans and military medical centers randomly assigned 1,092 Gulf War veterans with symptoms to one of four groups from April 1999 to September 2001.
The groups got either 12 weeks of usual care from inside or outside veterans and military hospitals; usual care plus an hour of weekly aerobic exercise with a physical therapist or exercise therapist, with two to three more sessions of exercise on their own; usual care plus 60 to 90 minutes of weekly group therapy; or usual care combined with exercise and therapy. Usual care consisted of any medical attention the veterans had received, including treatments to relieve some of their symptoms, such as pain.
After a year, researchers found improvements in physical functioning among 11.5% of veterans getting usual care, 11.7% of those getting exercise, 18.4% of those getting group therapy plus exercise, and 18.5% of those getting group therapy.
All groups but those getting usual care posted improvements in memory, concentration, attention and mental health functioning, while exercise or exercise plus therapy also reduced fatigue and distress.
Both the study authors and Brix said ill veterans might do even better with individualized, one-on-one cognitive behavioral therapy.