TABLE 6-11 Fibromyalgia and Chronic Widespread Pain

Study

Study Design

Population

Outcomes

Results

Adjustments

Comments

Eisen et al. 2005

Population-based, cross-sectional, prevalence, medical evaluation

1061 GW-deployed veterans, 1128 nondeployed veterans

Symptoms and physical examination for fibromyalgia with ACR criteria

OR 2.32, 95% CI 1.02-5.27

Age, sex, race, years of education, cigarette-smoking, duty type, service branch, rank

Uses gold standard for diagnosis of fibromyalgia; participation rates 53% deployed, 39% nondeployed

NHSGWEVTF

(Derived from Kang et al. 2000b)

Smith et al. 2000

Postwar hospitalization

551,841 GW-deployed, 1,478,704 nondeployed

Hospitalization records in 1991-1997 for fibromyalgia

RR 1.23, 95% CI 1.05-1.43; however, survival curves indicate excess due to hospitalization for purposes of evaluation during CCEP; before CCEP RR 0.92, 95% CI 0.74-1.13

Sex, age, branch of service

No increase after accounting for CCEP effect; limited to active duty; most cases of fibromyalgia not severe enough to warrant hospitalization

Ang et al. 2006

Cohort of veterans from IPGWSG

370 veterans who were free of CWP at 5 years were examined 10 years after war: 267 GW-deployed, 103 nondeployed

Structured telephone interview about 5 years after GW; in-person followup medical examination 10 years after war of 370 veterans who did not report chronic widespread pain 5 years after war

Neither deployment to nor time in gulf significantly correlated with CWP: OR 1.1, 95% CI 0.6-2.0 and OR 1.0, 95% CI 0.7-13, respectively; combat exposure correlated: OR 1.5, 95% CI 1.1-2.0; perception of stress due to military experience at time of GW correlated more significantly with CWP: OR 1.6, 95% CI 1.1-2.3, p = 0.0084

Controls matched for age, sex, branch of service

Potential for recall bias; only veterans who were free of CWP at 5 years were assessed 10 years after war

NOTE: ACR = American College of Rheumatology, CCEP = Comprehensive Clinical Evaluation Program, CI = confidence interval, CWP = chronic widespread pain, GW = Gulf War, IPGWSG = Iowa Persian Gulf War Study Group, NHSGWEVTF = National Health Survey of Gulf War Era Veterans and Their Families, OR = odds ratio, RR = relative risk.



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