A 1997 mail survey of the entire cohort of Canadian Gulf War-deployed veterans and a comparison group of nondeployed veterans—group-matched to cases on sex, age, and regular or reserve status—found that the Gulf War veterans were more likely (16%) to report symptoms of fibromyalgia than nondeployed veterans (about 10%) (Goss Gilroy Inc. 1998). Veterans were also asked about exposure to psychologic stressors, physical trauma, ionizing radiation, and other CNS agents. After adjustment for income, service branch, rank, and age, an OR of 1.81 (95% CI 1.55-2.13) was derived from the prevalence of fibromyalgia in deployed and nondeployed veterans. However, among deployed veterans, exposure to psychologic stressors and physical trauma also increased the likelihood of symptoms of fibromyalgia (OR 1.86, 95% CI 1.47-2.37 and OR 1.64, 95% CI 1.28-2.11, respectively), as did reported exposure to CNS agents and radiation and having lower rank and income. In both deployed and nondeployed veterans, the prevalence of fibromyalgia symptoms did not vary according to whether the veteran had other theater experience in the preceding 12 years. The main study limitation was diagnosis of fibromyalgia based on symptoms or self-reported diagnosis without physical examination.
Using data from the Iowa Persian Gulf Study Group (1997), Forman-Hoffman et al. (2007) analyzed information from the structured telephone interview conducted with 1896 deployed regular military, National Guard, and reserves and 1799 nondeployed veterans in 1995-1996. They looked for self-reports of symptoms of CWP according to the following criteria: the veteran reported having fibromyalgia or fibrositis in the previous 12 months or reported overall body pain that occurred almost every day for at least 3 months during the previous 12 months and had body pain in the 24 hours before the interview. The deployed veterans reported significantly more symptoms of CWP than did nondeployed veterans (OR 2.03, 95% CI 1.60-2.58), whether in the regular military or in the National Guard or reserves; the OR was adjusted for age, sex, race, rank, branch of service, military status, smoking, and current income. Veterans who met the researchers’ definition of CWP also had more impairment, such as bed days and VA disability and compensation, and they were more likely to be unemployed, to report their health status as fair or poor, and to have greater use of health care than those without CWP.
Stimpson et al. (2006) surveyed UK veterans who had served only in the Gulf War (n = 2959), only in Bosnia (n = 2052), or both in the Gulf War and in Bosnia (n = 570) and a comparison era group of veterans who had not been deployed to either the Gulf War or Bosnia (n = 2614) for self-reports of CWP. A mailed questionnaire containing a pain manikin to ascertain the pattern and intensity of pain was sent to 12,592 male and female veterans in 1997; the response rate was 60-70%. Veterans were selected for each deployment group on the basis of stratified random sampling of all UK Gulf War veterans. Data from the shaded manikins were used to determine whether the pain pattern met the ACR definition of CWP. The prevalence of reporting of CWP in the Gulf War-deployed group (16.8%) and the Gulf War- and Bosnia-deployed group (15.8%), but not in the Bosnia only-deployed group (7.6%), was statistically significantly higher (p < 0.0001) than that in the era group (8.5%) even when adjusted for socioeconomic and demographic factors. The pattern of pain was similar in all the groups; the most common sites of pain were the back and knees. Veterans who reported pain in one limb were also 30 times more likely to report pain in the symmetrically opposite limb rather than a second limb on the same side of the body; the authors found this suggestive of “systemic pain” rather than pain from an injury. Although the sample was large, the study is limited by a lack of physical examination and a lack of indication as to whether the veterans had sustained injuries during deployment or were using pain medication at the time of the survey.