SYSTEMATIC REVIEW OF TREATMENTS FOR
CHRONIC MULTISYMPTOM ILLNESS

The committee conducted a systematic review of treatments for CMI, following guidance in Finding What Works in Health Care: Standards for Systematic Reviews (IOM, 2011) and the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green, 2011).

In January 2012, a number of reference databases—PubMed, Embase, The Cochrane Library (Cochrane Central Register of Controlled Trials, Health Technology Assessment, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness [DARE]), American College of Physicians (ACP) Journal Club, PsycINFO, and Web of Science—were searched by using terms relevant to treatment for CMI.1 An additional database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), was searched in April 2012. The search was limited to literature published in 2000–2012 to identify evidence that had become available since a previous Institute of Medicine report, Gulf War Veterans: Treating Symptoms and Syndromes (IOM, 2001) was released. Searches were limited to adult populations. Additional potentially eligible studies were identified by hand searching of reference lists of relevant review articles.

Gray-literature sources were searched in April 2012 by using the approach outlined in Grey Matters: A Practical Search Tool for Evidence-Based Medicine (CADTH, 2011). Sources searched included the Food and Drug Administration, VA, Health Canada, the Australian Government Department of Health and Aging, the European Commission on Public Health, the System for Information on Grey Literature in Europe, Veterans Affairs Canada, and the Agency for Healthcare Research and Quality (AHRQ). Databases of clinical trials (Congressionally Directed Medical Research Programs, DeployMed ResearchLINK, BioMed Central current controlled trials, International Federation of Pharmaceutical Manufacturersand Associations clinical-trials portal, Thomson CenterWatch Clinical Trials Listing Service, UK Clinical Research Network Study Portfolio, US National Institutes of Health’s ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform Search Portal) and clinical practice guidelines (for example, the VA–Department of Defense [VA–DOD] Clinical Practice Guidelines website and the National Guideline Clearing House) were also included in the search. Search terms included CMI, Gulf War syndrome, Gulf War illness, unexplained illness, undiagnosed illnesses, undiagnosed symptoms, medically unexplained symptoms, somatoform disorder, fatigue, pain, concentration, memory, headaches, and

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1The strategy used to search PubMed can be found in the public-access file for this study. For information on accessing the public-access file, visit http://www8.nationalacademies.org/cp/projectview.aspx?key=49452.



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