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who 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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