Cognitive behavioral therapy and exercise minimally help Gulf War veterans’ illnesses
The Journal of Family Practice. 2003 June;52(6):431-454
June 1, 2003|Family Medicine
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- BACKGROUND: Many Gulf War veterans have reported persistent pain, fatigue, and cognitive problems. This multisystem complex is similar to, and cannot be clinically distinguished from, other chronic multisystem illnesses such as chronic fatigue syndrome and fibromyalgia. These other illnesses have been successfully treated by cognitive behavioral therapy and aerobic exercise.
- POPULATION STUDIED: This Veteran’s Administration cooperative study enrolled veterans who were deployed to the Gulf War between August 1990 and August 1991 and complained of at least 2 of the following 3 symptoms: fatigue, musculoskeletal pain involving 2 or more regions of the body, and cognitive symptoms (memory, concentration, or attention difficulties). These symptoms must have begun after August 1990, lasted for more than 6 months, and persisted at the time of screening.
- STUDY DESIGN AND VALIDITY: Subjects were randomized to 1 of 4 treatment groups: usual care, cognitive behavioral therapy plus usual care, aerobic exercise plus usual care, and cognitive behavioral therapy and aerobic exercise plus usual care. Cognitive behavioral therapy or exercise groups met 1 hour per week for 12 weeks.
- OUTCOMES MEASURED: The primary outcome was the percentage of veterans who improved more than 7 points on the physical component summary compared with baseline. Secondary outcomes were changes in the self-measurements of pain, fatigue, cognitive difficulties, physical conditioning, and mental health-related functioning.
- RESULTS: Ninety-one percent of subjects completed the 12-month follow-up visit. No significant differences in the primary outcome (physical component summary score) were found between treatment groups when correcting for multiple measurements. Only exercise alone showed a significantly higher (P=.02) improvement among adherent subjects (attending 8 or more weekly meetings) compared with nonadherent subjects.
PRACTICE RECOMMENDATIONS
Cognitive behavioral therapy and aerobic exercise provide only modest relief from symptoms of Gulf War veterans’ illnesses. Unfortunately, over 80% of the patients showed no improvement of symptoms after 1 year of either or both treatments. With the Iraqi war ending, the outcomes of veterans of this previous conflict may prove significant.
