TABLE D.2 Overlap of Symptoms

 

Fibromyalgia

Chronic Fatigue Syndrome

Multiple Chemical Sensitivity

Gulf War Illnesses

Symptoms:

 

Back pain

X

 

 

 

Joint pain

X

X

X

X

Extremity pain

X

X

X

X

Headache

X

X

X

X

Weakness

X

X

X

X

Fatigue

X

X

X

X

Sleep disturbance

X

X

X

 

Difficulty concentrating

X

X

X

X

Nasal congestion

 

 

X

 

Throat soreness

 

 

X

 

Etiology

Unknown

Unknown

Unknown

Unknown

Pathology biomarkers

• HPA dysregulation

• Growth hormone deficiency

• HPA dysregulation

• Immune activation

Unknown

Unknown

in ICD-10 (WHO, 1992). Multiple chemical sensitivity (MCS) continues to be poorly characterized and more controversial among clinicians. One major reason is that chemical sensitivity at extremely low doses appears to defy principles of toxicology (Sparks et al., 1994; Reid, 1999). A recent review, commissioned by the United Kingdom Health and Safety Executive, identified “suggestive” evidence that MCS exists as a clinical entity (Graveling et al., 1999), yet this review is unlikely to quell skepticism about MCS.

The first indication of Gulf War veterans reporting symptoms consistent with these conditions emerged from the DoD and VA registries (Joseph, 1997; Murphy et al., 1999).14 The large, well-designed epidemiologic studies summa-

14  

A diagnosis of fibromyalgia was made for 18 percent of 1,150 DoD registry patients referred for rheumatological evaluation of musculoskeletal complaints (Erickson et al., 1998). The overall frequency of fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity in veterans participating in VA and DoD registries has not been published. Compilation would be difficult because in the early years, codes for chronic fatigue syndrome and fibromyalgia were not listed in ICD-9-CM, the coding system on which registries relied. Classification codes listing chronic fatigue syndrome (as “postviral fatigue syndrome” or “neurasthenia”) and fibromyalgia were introduced in ICD-10 (WHO, 1992), but this classification system is not yet fully implemented in the United States. Neither ICD-9 nor ICD-10 contains codes for multiple chemical sensitivity. In



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