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Page 123 6 Conclusion Despite the fact that the Gulf War was short in duration with 148 combat deaths, health consequences linger 10 years after the fighting ended. Military personnel who served in the Gulf have a significantly higher risk than those who were not deployed to Southwest Asia of suffering symptoms of fatigue, memory loss, difficulty concentrating, pains in muscles and joints, headache, depression, and anxiety. Symptoms range in severity from the barely detectable to completely debilitating, and no single accepted case definition or etiology has been identified that describes or explains this cluster of symptoms. Numerous research efforts addressing Gulf War veterans' health have attempted to answer many different questions. What health effects might be attributable to service in the Gulf? Are ill veterans receiving appropriate care? How can the federal government be better prepared to meet future obligations to protect the health of military personnel? In fullfilling its charge and responding to a congressional mandate, this committee and its report focused on answering two questions: 1. Are there effective treatments for some of the difficult-to-diagnose, ill-defined, or unexplained health problems experienced by Gulf War veterans? 2. In the future, what approach should be used to assess treatment effectiveness? The committee found that symptoms experienced by Gulf War veterans are similar to those experienced by patients in other circumstances
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Page 124who have conditons of unknown etiology, including chronic fatigue syndrome (fatigue, headache, cognitive dysfunction, and other symptoms), depression (fatigue, loss of memory and other general symptoms, cognitive dysfunction, and sleep disturbances), fibromyalgia (joint pain, sleep disturbances, fatigue), and irritable bowel syndrome (diarrhea, constipation, abdominal pain, nausea, vomiting, and other gastrointestinal symptoms). Other symptoms reported by Gulf War veterans correspond to the diagnoses of headache and panic disorder. Because of its prevalence in veterans' populations and for purposes of completeness, posttraumatic stress disorder is also included in this report, even though the Department of Veterans Affairs is an acknowledged leader in the treatment of posttraumatic stress disorder. The committee examined treatments for these diagnoses to learn what might be borrowed from these conditions to apply to the treatment of Gulf War veterans. Treatment recommendations are based on demonstrated efficacy in randomized controlled trials. In addition to these diagnoses, the committee examined approaches to the treatment of individuals with medically unexplained symptoms. No randomized controlled trials have been conducted on treatments for medically unexplained symptoms; therefore, no specific treatment recommendations could be made. However, the committee explored current theories and research on treatment and has recommended a patient-centered approach to care that is appropriate for both those with medically unexplained symptoms and those who receive a diagnosis. Veterans of conflicts as far back as the Civil War reported health problems similar to those experienced by Gulf War veterans (Hyams et al. 1996). Research into the consequences of war-related illnesses and deployment-related health effects is beginning to examine ways to prevent or at least mitigate such problems. While research proceeds, we are faced with the task of providing effective treatments to Gulf War veterans who are suffering from difficult-to-diagnose, ill-defined, or unexplained illnesses. The committee hopes that the findings and recommendations contained in this report will aid in treating ill Gulf War veterans and in helping devise approaches to assessing the effectiveness of other treatments for these veterans.
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