Index

A

Access to care community-based outpatient clinics, 7, 158

facility locations, 163

integrated primary and mental health care, 163

medical records, 163, 166

specialty care access network, 4, 6, 7, 9, 159-160, 185, 187, 188, 189, 191

VA enrollment priority groups, 162, 164-165

wait time for appointment, 163

Acetaminophen, 38, 99

Acupuncture, 9, 35, 76, 78, 80-81, 97, 100, 102, 107, 120, 121, 191

Afghanistan veterans, defined, 1 n.1

Agency for Healthcare Research and Quality (AHRQ), 9, 30, 32, 34, 37, 40, 41, 55, 73, 78, 79, 191

Agent Orange, 12, 164

American Academy of Sleep Medicine, 102

American Academy on Communication in Healthcare (AACH), 145

American College of Gastroenterology, 105

American College of Physicians (ACP), 30, 32, 33

American College of Rheumatology, 94

American Psychiatric Association, 100, 108, 110, 111, 116, 118

Amitriptyline, 38, 95, 120

Anticonvulsants, 39, 96, 120

Antidepressants, 39, 40, 46-47, 66-67, 68-69, 70-71, 86, 96, 101, 105, 107, 108, 118, 120, 143, 144, 207-208, 210

Antipsychotics, 39, 107

Anxiety biofeedback interventions, 72, 74-75, 108, 120

causes, 17, 203

and CMI, 1, 3, 4, 11, 16, 17, 18, 24, 29, 32, 108, 185, 205

cognitive behavioral therapy, 108, 113, 120

comorbid conditions, 49, 93, 94, 100, 101, 103-104, 105, 106, 108, 109, 112, 113, 114

diagnosis, 16, 17, 100, 108, 109

exercise therapy, 77, 80-81, 84-85

and pain, 205

pharmacologic interventions, 39, 42-43, 44-45, 46-47, 72, 86, 101, 104, 105, 108, 118, 119, 120, 121

prevalence, 16, 24, 108

psychodynamic therapy, 52, 53, 54, 64-65, 66-67, 108, 121



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Index A American Psychiatric Association, 100, 108, 110, 111, 116, 118 Access to care Amitriptyline, 38, 95, 120 community-based outpatient clinics, 7, Anticonvulsants, 39, 96, 120 158 Antidepressants, 39, 40, 46-47, 66-67, facility locations, 163 68-69, 70-71, 86, 96, 101, 105, 107, integrated primary and mental health 108, 118, 120, 143, 144, 207-208, care, 163 210 medical records, 163, 166 Antipsychotics, 39, 107 specialty care access network, 4, 6, 7, 9, Anxiety 159-160, 185, 187, 188, 189, 191 biofeedback interventions, 72, 74-75, VA enrollment priority groups, 162, 108, 120 164-165 causes, 17, 203 wait time for appointment, 163 and CMI, 1, 3, 4, 11, 16, 17, 18, 24, 29, Acetaminophen, 38, 99 32, 108, 185, 205 Acupuncture, 9, 35, 76, 78, 80-81, 97, 100, cognitive behavioral therapy, 108, 113, 102, 107, 120, 121, 191 120 Afghanistan veterans, defined, 1 n.1 comorbid conditions, 49, 93, 94, 100, Agency for Healthcare Research and 101, 103-104, 105, 106, 108, 109, Quality (AHRQ), 9, 30, 32, 34, 37, 112, 113, 114 40, 41, 55, 73, 78, 79, 191 diagnosis, 16, 17, 100, 108, 109 Agent Orange, 12, 164 exercise therapy, 77, 80-81, 84-85 American Academy of Sleep Medicine, 102 and pain, 205 American Academy on Communication in pharmacologic interventions, 39, 42-43, Healthcare (AACH), 145 44-45, 46-47, 72, 86, 101, 104, 105, American College of Gastroenterology, 105 108, 118, 119, 120, 121 American College of Physicians (ACP), 30, prevalence, 16, 24, 108 32, 33 psychodynamic therapy, 52, 53, 54, American College of Rheumatology, 94 64-65, 66-67, 108, 121 211

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212 GULF WAR AND HEALTH psychotherapy, 50, 51, 58-59, 60-61, cognitive behavioral therapy, 54, 68-69, 62-63, 108, 113, 120, 121 99, 120 relaxation techniques, 100, 108, 121 comorbid conditions, 97, 100 St. John’s wort treatment, 77-78, 82-83 definitions, 22, 97, 98 suicide and suicidal ideation, 118-119 and depression, 100, 119 Assessment of Multiple Systematic Reviews diagnosis, 23, 97 (AMSTAR), 32, 53, 54 exercise therapy, 99 Australian National Health and Medical prevalence, 97 Research Council Guideline, 111 sensitivity to medications, 99 Autogenic training (self-hypnosis), 57 symptoms, 11, 97, 99 treatments, 4, 32, 33, 54, 99-100, 120, 205 B Chronic pain (see also Fibromyalgia) acupuncture, 97, 100, 120, 173 Benefits Delivery at Discharge program alternative therapies, 100, 116 (BDD), 166 biofeedback, 120 Biofeedback, 37, 56 in civilians, 22 anxiety, 72, 74-75, 108, 120 clinician education, 160 chronic pain, 120 and CMI, 1, 4, 11, 22, 95-96, 107, 114, depression, 74-75 118, 159, 185, 186, 205 effectiveness, 66-67, 72-73, 74-75, 101 comorbid conditions, 32, 93, 96, 98, 99, fibromyalgia, 66-67 101, 103, 106, 110, 112, 114, 119, plus pharmacotherapy, 72, 74-75 185, 186 research needs, 9, 191 defined, 95 somatic symptom disorders, 57, 72-73, exercise interventions, 84-85, 99, 116, 74-75, 101, 120 120, 158 strength of evidence, 73 eye movement desensitization and Buprenorphine, 115, 122 reprocessing, 70-71 Bupropion, 115, 122 facial, 107 low back pain, 16, 120 models of care, 135, 139, 141, 144, 158, C 159, 168, 173, 208, 209 Centers for Disease Control and Prevention musculoskeletal, 11, 16, 22, 24, 25-26, (CDC), 22, 23, 97 98, 107 Characterizing CMI patient education, 158 causes/underlying factors, 1, 11-13, pharmacologic interventions, 42-43, 203-205 44-45, 95, 96, 99, 105, 114, 116, management vs curing, 26-27 119, 120, 210 prevalence, 2, 23-26 physiological mechanisms, 203-204, 205 risk factors, 26 prevalence in veterans, 16, 24, 25-26, symptoms, 1, 16, 21-22, 23 95-96 terminology, 21-22 Project ECHO, 160 veteran vs civilian populations, 26 psychodynamic therapy, 64-65 working definition, 1, 23 psychotherapy interventions, 54, 60-61, Charge to committee, 2-3, 13-14 68-69, 116, 120 approach to, 3 radiofrequency ablation of branch Chronic fatigue syndrome nerves, 96, 120 clinician–patient communication, 140 REAC-BS treatment, 40, 48-49 and CMI, 1, 3, 4, 15, 18, 23, 29, 32, 97, relaxation techniques, 100, 120 99, 185, 203

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INDEX 213 and substance-use disorders, 114, 116, Cognitive rehabilitation therapy (CRT), 37, 122 38, 73, 76-77, 113 transcutaneous electric nerve Columbia-Suicide Severity Rating Scale, stimulation, 96-97, 120 116-117 Classical Acupuncture Treatment for Combat fatigue, 11 People with Unexplained Symptoms Comorbid and related conditions (CACTUS) study, 76 anxiety, 1, 3, 4, 11, 16, 17, 18, 24, 29, Clinical practice guidelines (CPGs), 5, 7, 29, 32, 108, 185, 205 30, 32-33, 94, 102, 111, 115, 155, chronic fatigue syndrome, 1, 3, 15, 18, 158-159, 161, 169, 172, 173, 186 23, 29, 32, 97, 99, 185, 203 Clinician-Administered PTSD Scale, 109 chronic pain, 1, 4, 11, 22, 95-96, 107, Cochrane Risk of Bias Tool, 32 114, 118, 159, 185, 186, 205 Cognitive behavioral therapy, 4, 86 depression, 1, 3, 4, 11, 16, 18, 24, 29, for anxiety disorders, 108, 113, 120 32, 106-107, 118, 185 for chronic fatigue syndrome, 54, 68-69, fibromyalgia, 1, 18, 23, 29, 32, 94, 97 99, 120 functional gastrointestinal disorders, 1, for chronic pain, 120 102-106 clinical guidelines, 159 general therapeutic approach, 119-122 clinician training, 135 posttraumatic stress disorder, 4, 11, 26, components, 49 32, 109-111, 185 consultation letter, 70-71 self-harm, 117-118 for depression and suicide risk, 107, sleep disorders, 4, 16, 21, 25-26, 101- 113, 119, 121, 122 102, 107, 159, 185 effectiveness, 41, 46-47, 49, 50, 53, somatic symptom disorders, 4, 22, 32, 54-55, 56-63, 95, 115, 120-122, 97, 99, 100-101, 185, 203, 204, 205 184, 185 substance-use disorders, 113-116 exercise plus, 38, 50-51, 60-61, 79, traumatic brain injury, 111-113 84-85, 99, 120, 169, 184 Compensation (see Disability compensation for fibromyalgia, 54, 68-69, 95, 120 for undiagnosed illnesses) for functional gastrointestinal disorders, Complementary and alternative medicine, 4 106, 121 acupuncture, 9, 35, 76, 78, 80-81, 97, group, 50-51, 55, 58-59, 60-61, 62-63, 100, 102, 107, 120, 121, 191 70-71, 79, 111, 184 continuous positive airway pressure, 99, Gulf War Veterans’ Illnesses, 60-61, 84-85 120 individual, 49-50, 55, 70-71, 111, 184 defined, 73, 76 medically unexplained symptoms, 60-63, Kampo, 76, 77, 78, 82-83 70-71 movement therapies, 63, 76-77, 78 multimodal therapy, 95 outcomes and results, 80-83 psychiatric consultation intervention for PTSD, 111 with, 56-57, 135 research recommendations, 9, 191 and psychodynamic psychotherapies, 52 St. John’s wort, 9, 76, 77-78, 80-81, for sleep disorders, 49, 102, 121 82-83, 184, 191 somatic-focused, 41, 49, 51, 55-56 strength of evidence, 78 somatoform disorders, 41, 46-47, 50, Tai Chi, 63, 100, 120 51, 53, 56-59, 62-63, 68-69, 70-71, yoga, 63, 100, 120 72, 108, 113, 120, 184 Composite International Diagnostic for substance-abuse disorders, 115, 122 Interview, 72 telephone or Internet implementation, Consolidated Standards of Reporting Trials, 107 9, 191 trauma-focused, for PTSD, 50, 111, 121

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214 GULF WAR AND HEALTH Consultations with mental health experts, models of care, 176, 207-208, 210 12, 46-47, 49, 53, 66-67, 68-69, pharmacologic interventions, 38, 39, 70-71, 72, 101, 120, 135-136 42-43, 44-45, 46-47, 86, 95, 105, ConsumerSphere, 34 107, 118, 119, 120, 121 Continuity of care, 144, 159, 169 prevalence, 16, 106 Continuous quality improvement, 149, 170, psychodynamic therapy, 66-67, 68-69, 176 70-71, 121 Coordination of care, 5, 7, 8, 12, 96, 107, psychotherapy, 50, 58-59, 60-61, 62-63, 159, 161, 168, 169, 186, 187, 188, 107, 113, 121 189-190 St. John’s wort treatment, 82-83 Cyclobenzaprine, 95 suicide and suicidal ideation, 106, 107, 116, 118-119 symptoms, 106-107 D Disability compensation for undiagnosed illnesses, 23, 166-167 Da Costa’s syndrome, 11, 22 Dissemination of information on CMI, 3, Data collection and quality, 3, 8, 142, 183, 7-8, 171, 174, 183, 188-190 190 DocCom, 145 Department of Veterans Affairs Health Care Doxycycline, 38, 39, 40, 41, 42-43, 184 System Duloxetine, 38, 95, 120 clinical practice guidelines, 158-159 educational materials, 158 Office of Patient Centered Care and E Cultural Transformation, 160 post-deployment patient-aligned care Education (see Patient education; Training team, 4, 5, 157-158, 185, 186, 187 of clinicians) specialty care access network, 4, 6, 7, 9, Electroconvulsive therapy, 107, 121 159-160, 185, 187, 188, 189, 191 Electronic health records (EHRs), 5, 134, summary of models of care, 161 146, 147, 163-164, 176, 186 War-Related Illness and Injury Study Enhanced medical care (EMC), 52, 66-67 Centers (WRIISC), 4, 6, 7, 9, 160, Escitalopram, 39, 40, 41, 46-47 169, 173, 185, 188, 190, 191 Exercise Depression aerobic, 9, 46-47, 60-61, 68-69, 79, acupuncture for, 107, 121 84-85, 95, 120, 159 biofeedback interventions, 74-75 anxiety, 77, 80-81, 84-85 causes, 203 chronic fatigue syndrome, 99 chronic fatigue syndrome and, 100, 119 chronic pain, 84-85, 99, 116, 120, 158 chronic pain and, 93, 94 cognitive behavioral therapy plus, 38, and CMI, 1, 3, 4, 11, 16, 18, 24, 29, 32, 50-51, 60-61, 79, 84-85, 95, 99, 106-107, 118, 185 120, 159, 169, 184 cognitive behavioral therapy, 107, 113, depression, 77, 80-81, 84-85, 107, 121 119, 121, 122 effectiveness, 79, 84-85 comorbid conditions, 49, 93, 94, 97, fibromyalgia, 95, 120 100, 101, 103-104, 105, 108, 109, Gulf War Veterans’ Illnesses, 60-61, 84-85 112, 113, 114, 120, 121 research needs, 9, 191 diagnosis, 16, 106, 116 sleep disorders, 102 electroconvulsive therapy, 107, 121 somatic symptom disorders, 46-47, 53, exercise interventions, 77, 80-81, 84-85, 68-69, 77, 78, 80-81, 84-85 107, 121 strength of evidence, 79, 84 major depressive disorder, 16, 106, 118- substance-use disorders, 116, 122 119, 121 Eye movement desensitization and reprocessing (EMDR), 54, 70-71

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INDEX 215 F Institute of Medicine (IOM), 2-3, 9, 12, 13, 14, 15, 22, 30, 113, 191 Family support, 116 Integrated Disability Evaluation System Fibromyalgia (IDES), 166, 167 biofeedback intervention, 66-67 International and Interagency Initiative cause, 94, 203, 205 toward Common Data Elements for clinician–patient communication, 140 Research on Traumatic Brain Injury and CMI, 1, 4, 18, 23, 29, 32, 94, 97 and Psychological Health, 112 cognitive behavioral therapy, 54, 68-69, International Society for Traumatic Stress 95, 120 Studies Guidelines, 111 comorbid conditions, 104 Iraqi War veterans, defined, 1 n.1 diagnostic criteria, 22, 23, 94 Irritable bowel syndrome (IBS) exercise therapy, 95, 120 cause, 203, 204 multimodal therapy, 95, 120 clinician–patient communication, 140, pharmacologic interventions, 33, 38, 40, 210 94-95, 119, 120 and CMI, 1, 3, 18, 22, 23, 29, 97, 103- prevalence, 94 104, 185, 205 symptoms, 3, 22, 94 diagnosis, 23, 103, 203 Functional dyspepsia, 4, 102-103, 104, 105, hypnosis and, 106 121, 185, 204 pharmacologic treatments, 105, 119 Functional gastrointestinal disorders (see prevalence, 103 also Functional dyspepsia; Irritable psychodynamic interventions, 53-54, bowel syndrome) 66-67 and CMI, 102-104 psychotherapy, 54, 68-69, 105-106 nonpharmacologic treatments, 105-106 symptoms, 103, 104, 204 pharmacologic treatments, 105 treatments, 4, 33, 53-54, 66-67, 68-69, 104, 105-106, 119, 121 Irritable colon syndrome, 50 G Irritable heart, 11, 22 Gabapentin, 38, 95, 120 Gulf War syndrome, 22 Gulf War veteran population J defined, 1 n.1 Jungian therapy, 52, 64 prevalence of CMI, 2, 24-26 Gulf War Veterans’ Illnesses, 22, 40, 60-61, 84-85 K Kampo, 76, 77, 78, 82-83 H HEROES study, 26 L Hypervigilance, 25, 105, 109, 110, 205 Hypnosis, 46-47, 68-69, 72, 106, 121 Learning networks, 7-8, 149, 170, 175, 189 Hypochondriasis, 50, 60-61, 68-69 Levosulpiride, 40, 41, 42-43 I M Image rehearsal therapy, 102, 121 Management of care (see Patient-centered Institute for Healthcare Communication, 145 care for CMI) Institute for Healthcare Improvement, 170 Methadone, 115, 122

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216 GULF WAR AND HEALTH Methods of review Nefazodone, 39, 40, 41, 44-45 comorbid conditions with shared Nonsteroidal anti-inflammatory drugs, 38, symptoms, 32-34 96, 99, 120 current research, 35 data abstraction and assessment, 32 generalizability of studies, 4, 39, 86, 184 O health outcomes assessed, 15 Operation Desert Storm, 1 n.1, 15 information sources, 29-30, 32-35 Operation Enduring Freedom, 1 n.1, 15, 25 public meetings and social media review, Operation Iraqi Freedom, 1 n.1, 15, 25 32-35 Operation New Dawn, 1 n.1, 15, 25 selection of evidence, 31 Opioid analgesics, 25, 38, 96, 114, 115, summary of literature search and study 116, 120, 122 selection process, 31-32, 33 Opipramol, 39, 40, 41, 46-47 systematic review of treatments, 30-32 Mind–body approached (see Biofeedback; Cognitive rehabilitation therapy; Complementary and alternative P medicine) Pain (see Chronic pain) Mirtazapine, 39, 42-43 Paroxetine, 39, 40, 41, 44-45 Models of care (see also Department of Patient-aligned care teams (PACTs), 5-6, Veterans Affairs Health Care System) 7, 9, 157-158, 167-170, 187, 188, civilian settings, 173 189, 191 clinician behavior change, 175-176 Patient-centered care for CMI (see also committee approach, 3 Patient–clinician relationship) depression, 176, 207-208, 210 consultations with mental health experts, disseminating evidence-based guidelines, 12, 135-136 173-175 coordination of care, 5, 7, 8, 12, 96, implementation of changes, 171-173, 174 107, 159, 161, 168, 169, 186, 187, organization of services for veterans 188, 189-190 with CMI, 167-173 information and communication PACTs, 5-6, 7, 9, 157-158, 167-170, technologies, 146-149 187, 188, 189, 191 rationale for, 17 Plan Do Study Act (PDSA), 170-171, training of clinicians, 7, 8, 47, 69, 79, 172 133-136, 138, 145, 149, 160, 161, postseparation comprehensive health 162, 170, 188-190, 207-210 assessment, 167-169 VHA Office of Patient Centered Care Monoamine oxidase inhibitors, 38 and Cultural Transformation, 160 Motivational interviewing (MI), 9, 115, Patient–clinician relationship 138-139, 191 communication skills, 7, 8, 136-137, Movement therapies, 63, 76-77, 78 138-139, 140, 207-210 Myalgic encephalomyelitis (see Chronic determinants of good interactions, fatigue syndrome) 138-139 patient perceptions of, 137-138 recommendations for improving, N 139-145 resources for clinicians, 145 Naltrexone, 35, 115, 122 Patient education National Collaborating Center for Primary Internet and social media use, 17, 147 Care, 108 pain management, 158 National Institute for Health and Clinical substance-use disorders, 116 Excellence, 108 VHA-provided materials, 158

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INDEX 217 Patient experiences of care, 6, 16-17, 32, cognitive behavioral therapy with, 52 59, 136, 143, 161-162, 187, 190 depression, 66-67, 68-69, 70-71, 121 Patient satisfaction, 161-162 dynamic psychotherapy, 64-65 Persian Gulf War Veterans Act of 1998, 12 group, 53, 55, 64-65 Pharmacologic interventions (see also individual, 52-53, 55 specific agents) outcomes and results, 64-67 anxiety, 39, 42-43, 44-45, 46-47, 72, 86, somatic symptom disorders, 52-53, 54, 101, 104, 105, 108, 118, 119, 120, 64-65, 66-67 121 strength of evidence, 55 chronic pain, 42-43, 44-45, 95, 96, 99, studies, 51 105, 114, 116, 119, 120, 210 Psychotherapies (see also Cognitive depression, 38, 39, 42-43, 44-45, 46-47, behavioral therapy; Psychodynamic 86, 95, 105, 107, 118, 119, 120, 121 psychologic interventions) effectiveness, 42-48 anxiety, 50, 51, 58-59, 60-61, 62-63, fibromyalgia, 33, 40, 94-95, 119, 120 108, 113, 120, 121 functional gastrointestinal disorders, chronic pain, 64-65 105, 119 reviews, 53-54 PTSD, 102, 111, 119, 121 strength of evidence, 55 sleep disorders, 95, 99, 102, 105, 120, for substance-use disorders, 115-116 121 summary of, 54-56 somatic symptom disorders, 39, 40, systematic reviews, 66-71 42-47, 53, 72, 74-75, 101, 119, 120 Pyridostigmine bromide, 13 strength of evidence, 41 substance-use disorders, 115, 122 traumatic brain injury, 113 Q Posttraumatic stress disorder (PTSD) Quick Start program, 166 clinical practice guidelines, 111, 158 and CMI, 4, 11, 26, 32, 109-111, 185 cognitive behavioral therapy, 50, 111, 121 R comorbidities, 96, 101, 102, 104, 109, Radioelectric asymmetric conveyer brain 186 stimulation (REAC-BS), 40-41, 48-49 complementary and alternative medicine, Radiofrequency ablation of branch nerves, 111 96, 120 diagnostic criteria, 109, 110 Reattribution training, 69, 135 patient–clinician communication, 144 Recommendations (see also Research pharmacotherapy, 102, 111, 119, 121 recommendations) post-Vietnam syndrome, 22 data collection and quality prevalence, 16, 25, 110 improvements, 8, 190 screening tools, 109 dissemination of information, 7-8, Prazosin, 102, 121 188-190 Preferred Reporting Items for Systematic improving care, 5-7, 186-188 Reviews and Meta-Analyses, 9, 191 treatments for CMI, 4-5, 183-185 Pregabalin, 38, 95, 96, 120 Relaxation interventions, 41, 49, 51, 57, Psychiatric consultation, 56-57, 135 60-61, 66-67, 72, 74-75, 100, 102, Psychodynamic interpersonal therapy (PIT), 106, 108, 120-121 53, 66-67, 106, 107, 119, 121, 122 Research recommendations Psychodynamic psychologic interventions evaluation of programs, 9, 191-192 anxiety, 52, 53, 54, 64-65, 66-67, 108, treatments for CMI, 8-9, 191 121 biopsychosocial intervention, 64-65

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218 GULF WAR AND HEALTH S exercise interventions, 46-47, 53, 68-69, 77, 78, 80-81, 84-85 Selective serotonin reuptake inhibitors hypersensitivity, 205 (SSRIs), 4, 38, 105, 107, 111, 118, hypnosis, 72 119, 120, 121, 185 Kampo, 77, 78 Self-harm pharmacologic treatments, 39, 40, and CMI, 4, 32, 117-118 42-47, 53, 72, 74-75, 101, 119, 120 screening measures, 116-117 psychodynamic psychotherapies, 52-53, treatments, 118-119 54, 64-65, 66-67 Serotonin–norepinephrine reuptake relaxation interventions, 41, 49, 51, 57, inhibitors (SNRIs), 4, 38, 95, 96, 60-61, 66-67, 72, 74-75, 100, 102, 105, 108, 119, 120, 121, 185 106, 108, 120-121 Shell shock, 11, 22 St. John’s wort, 77-78, 80-81, 82-83, Sleep disorders 184-185 acupuncture, 102 subthreshold, 72 circadian-rhythm sleep disorders, suicide risk, 117 101-102 terminology, 100 and CMI, 4, 16, 21, 25-26, 101-102, Specialty Care Access Network-Extension 107, 159, 185 for Community Healthcare cognitive behavioral therapy, 49, 102, Outcomes (SCAN-ECHO) programs, 121 4, 6, 7, 9, 159-160, 185, 187, 189, comorbidities, 32, 94, 97, 98, 99, 101, 191 102, 105, 106, 107, 109, 120, 205 St. John’s wort supplement, 9, 76, 77-78, continuous positive airway pressure, 99, 80-81, 82-83, 184, 191 120 Stimulus-control therapy, 102, 121 exercise therapy, 102 Substance-use disorders insomnia, 98, 101, 102, 106, 121 behavioral couples therapy, 115, 122 mind–body approaches, 102 clinician resources, 145 nightmare disorder, 101, 102 and CMI, 4, 25, 32, 114, 185 obstructive sleep apnea, 101 cognitive behavioral therapy, 115, 122 pharmacological treatments, 95, 99, comorbidities, 101, 109, 114 102, 105, 120, 121 diagnostic criteria, 113-114 prevalence, 16, 24, 25 exercise programs, 116, 122 rapid eye movement (REM) sleep family support, 116 behavior disorder, 101, 205 motivational interviewing, 138 relaxation therapies, 60-61, 100, 121 opioid pain management therapy and, symptoms, 100 114, 116, 122 treatments, 99, 102 patient education, 116 Sleep hygiene, 49, 99-100, 102, 120 pharmacologic treatments, 115, 122 Social media use, 3, 34, 137, 146, 147, 148, psychotherapy, 115-116 149 Suicide and suicidal ideation, 106, 107, Somatic symptom disorders, 100 116, 118-119 biofeedback, 57, 72-73, 74-75, 101, 120 Sulpiride, 39 and CMI, 4, 22, 32, 97, 99, 101, 185, 203, 204, 205 cognitive behavioral therapy, 41, 46-47, T 50, 51, 53, 56-59, 62-63, 68-69, 70-71, 72, 108, 113, 120, 184 Tai Chi, 63, 100, 120 comorbidities, 104, 106, 110 Topiramate, 38, 39, 40, 41, 42-43, 115, 122 diagnosis, 16, 22, 72 Toxic exposures, 12, 13

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INDEX 219 Training of clinicians, 7, 8, 47, 69, 79, 133- U 136, 138, 145, 149, 160, 161, 162, 170, 188-190, 207-210 US Food and Drug Administration (FDA), 95 Tramadol, 38, 95, 96 UK National Health Service, 97 Transcutaneous electric nerve stimulation, UK National Institute of Health and Clinical 96-97, 120 Excellence Guideline, 111, 118-119 Traumatic brain injury, 111-113 University of New Mexico Health System, access to care, 173 148 clinical practice guidelines, 158 and CMI, 4, 32, 112, 185 cognitive behavioral therapy, 121 V cognitive rehabilitation therapy, 113 Varenicline, 115, 122 comorbidities, 16, 109, 186 Venlafaxine, 39, 40, 41, 42-43, 44-45, 101, defined, 111-112 120 pharmacologic treatments, 113 Veterans Benefits Act of 2010, 2, 13 prevalence, 16, 25, 96, 112 Veterans Programs Enhancement Act of treatments, 113 1998, 12 stratification of severity, 112 symptoms, 93, 112 Treatments for CMI (see also individual W treatment approaches) adherence to, 43, 50-51, 52, 61, 79, War-Related Illness and Injury Study 105, 116, 136, 138, 139, 141 Centers (WRIISC), 4, 6, 7, 9, 160, general approach for medically 169, 173, 185, 188, 190, 191 unexplained physical symptoms, 12 multimodal approaches, 4, 9, 95, 96-97, 122, 185, 191 Y research recommendations, 8-9, 191 Yoga, 76, 100, 120 Tricyclic medications, 38, 95, 96, 105, 119, 120, 121, 185

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