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Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
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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

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

psychotherapy, 50, 51, 58-59, 60-61, 62-63, 108, 113, 120, 121

relaxation techniques, 100, 108, 121

St. John’s wort treatment, 77-78, 82-83

suicide and suicidal ideation, 118-119

Assessment of Multiple Systematic Reviews (AMSTAR), 32, 53, 54

Australian National Health and Medical Research Council Guideline, 111

Autogenic training (self-hypnosis), 57

B

Benefits Delivery at Discharge program (BDD), 166

Biofeedback, 37, 56

anxiety, 72, 74-75, 108, 120

chronic pain, 120

depression, 74-75

effectiveness, 66-67, 72-73, 74-75, 101

fibromyalgia, 66-67

plus pharmacotherapy, 72, 74-75

research needs, 9, 191

somatic symptom disorders, 57, 72-73, 74-75, 101, 120

strength of evidence, 73

Buprenorphine, 115, 122

Bupropion, 115, 122

C

Centers for Disease Control and Prevention (CDC), 22, 23, 97

Characterizing CMI

causes/underlying factors, 1, 11-13, 203-205

management vs curing, 26-27

prevalence, 2, 23-26

risk factors, 26

symptoms, 1, 16, 21-22, 23

terminology, 21-22

veteran vs civilian populations, 26

working definition, 1, 23

Charge to committee, 2-3, 13-14

approach to, 3

Chronic fatigue syndrome clinician–patient communication, 140

and CMI, 1, 3, 4, 15, 18, 23, 29, 32, 97, 99, 185, 203

cognitive behavioral therapy, 54, 68-69, 99, 120

comorbid conditions, 97, 100

definitions, 22, 97, 98

and depression, 100, 119

diagnosis, 23, 97

exercise therapy, 99

prevalence, 97

sensitivity to medications, 99

symptoms, 11, 97, 99

treatments, 4, 32, 33, 54, 99-100, 120, 205

Chronic pain (see also Fibromyalgia) acupuncture, 97, 100, 120, 173

alternative therapies, 100, 116

biofeedback, 120

in civilians, 22

clinician education, 160

and CMI, 1, 4, 11, 22, 95-96, 107, 114, 118, 159, 185, 186, 205

comorbid conditions, 32, 93, 96, 98, 99, 101, 103, 106, 110, 112, 114, 119, 185, 186

defined, 95

exercise interventions, 84-85, 99, 116, 120, 158

eye movement desensitization and reprocessing, 70-71

facial, 107

low back pain, 16, 120

models of care, 135, 139, 141, 144, 158, 159, 168, 173, 208, 209

musculoskeletal, 11, 16, 22, 24, 25-26, 98, 107

patient education, 158

pharmacologic interventions, 42-43, 44-45, 95, 96, 99, 105, 114, 116, 119, 120, 210

physiological mechanisms, 203-204, 205

prevalence in veterans, 16, 24, 25-26, 95-96

Project ECHO, 160

psychodynamic therapy, 64-65

psychotherapy interventions, 54, 60-61, 68-69, 116, 120

radiofrequency ablation of branch nerves, 96, 120

REAC-BS treatment, 40, 48-49

relaxation techniques, 100, 120

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

and substance-use disorders, 114, 116, 122

transcutaneous electric nerve stimulation, 96-97, 120

Classical Acupuncture Treatment for People with Unexplained Symptoms (CACTUS) study, 76

Clinical practice guidelines (CPGs), 5, 7, 29, 30, 32-33, 94, 102, 111, 115, 155, 158-159, 161, 169, 172, 173, 186

Clinician-Administered PTSD Scale, 109

Cochrane Risk of Bias Tool, 32

Cognitive behavioral therapy, 4, 86

for anxiety disorders, 108, 113, 120

for chronic fatigue syndrome, 54, 68-69, 99, 120

for chronic pain, 120

clinical guidelines, 159

clinician training, 135

components, 49

consultation letter, 70-71

for depression and suicide risk, 107, 113, 119, 121, 122

effectiveness, 41, 46-47, 49, 50, 53, 54-55, 56-63, 95, 115, 120-122, 184, 185

exercise plus, 38, 50-51, 60-61, 79, 84-85, 99, 120, 169, 184

for fibromyalgia, 54, 68-69, 95, 120

for functional gastrointestinal disorders, 106, 121

group, 50-51, 55, 58-59, 60-61, 62-63, 70-71, 79, 111, 184

Gulf War Veterans’ Illnesses, 60-61, 84-85

individual, 49-50, 55, 70-71, 111, 184

medically unexplained symptoms, 60-63, 70-71

multimodal therapy, 95

psychiatric consultation intervention with, 56-57, 135

and psychodynamic psychotherapies, 52

for sleep disorders, 49, 102, 121

somatic-focused, 41, 49, 51, 55-56

somatoform disorders, 41, 46-47, 50, 51, 53, 56-59, 62-63, 68-69, 70-71, 72, 108, 113, 120, 184

for substance-abuse disorders, 115, 122

telephone or Internet implementation, 107

trauma-focused, for PTSD, 50, 111, 121

Cognitive rehabilitation therapy (CRT), 37, 38, 73, 76-77, 113

Columbia-Suicide Severity Rating Scale, 116-117

Combat fatigue, 11

Comorbid and related conditions anxiety, 1, 3, 4, 11, 16, 17, 18, 24, 29, 32, 108, 185, 205

chronic fatigue syndrome, 1, 3, 15, 18, 23, 29, 32, 97, 99, 185, 203

chronic pain, 1, 4, 11, 22, 95-96, 107, 114, 118, 159, 185, 186, 205

depression, 1, 3, 4, 11, 16, 18, 24, 29, 32, 106-107, 118, 185

fibromyalgia, 1, 18, 23, 29, 32, 94, 97

functional gastrointestinal disorders, 1, 102-106

general therapeutic approach, 119-122

posttraumatic stress disorder, 4, 11, 26, 32, 109-111, 185

self-harm, 117-118

sleep disorders, 4, 16, 21, 25-26, 101-102, 107, 159, 185

somatic symptom disorders, 4, 22, 32, 97, 99, 100-101, 185, 203, 204, 205

substance-use disorders, 113-116

traumatic brain injury, 111-113

Compensation (see Disability compensation for undiagnosed illnesses)

Complementary and alternative medicine, 4

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

continuous positive airway pressure, 99, 120

defined, 73, 76

Kampo, 76, 77, 78, 82-83

movement therapies, 63, 76-77, 78

outcomes and results, 80-83

for PTSD, 111

research recommendations, 9, 191

St. John’s wort, 9, 76, 77-78, 80-81, 82-83, 184, 191

strength of evidence, 78

Tai Chi, 63, 100, 120

yoga, 63, 100, 120

Composite International Diagnostic Interview, 72

Consolidated Standards of Reporting Trials, 9, 191

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

Consultations with mental health experts, 12, 46-47, 49, 53, 66-67, 68-69, 70-71, 72, 101, 120, 135-136

ConsumerSphere, 34

Continuity of care, 144, 159, 169

Continuous quality improvement, 149, 170, 176

Coordination of care, 5, 7, 8, 12, 96, 107, 159, 161, 168, 169, 186, 187, 188, 189-190

Cyclobenzaprine, 95

D

Da Costa’s syndrome, 11, 22

Data collection and quality, 3, 8, 142, 183, 190

Department of Veterans Affairs Health Care System

clinical practice guidelines, 158-159

educational materials, 158

Office of Patient Centered Care and Cultural Transformation, 160

post-deployment patient-aligned care team, 4, 5, 157-158, 185, 186, 187

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

summary of models of care, 161

War-Related Illness and Injury Study Centers (WRIISC), 4, 6, 7, 9, 160, 169, 173, 185, 188, 190, 191

Depression acupuncture for, 107, 121

biofeedback interventions, 74-75

causes, 203

chronic fatigue syndrome and, 100, 119

chronic pain and, 93, 94

and CMI, 1, 3, 4, 11, 16, 18, 24, 29, 32, 106-107, 118, 185

cognitive behavioral therapy, 107, 113, 119, 121, 122

comorbid conditions, 49, 93, 94, 97, 100, 101, 103-104, 105, 108, 109, 112, 113, 114, 120, 121

diagnosis, 16, 106, 116

electroconvulsive therapy, 107, 121

exercise interventions, 77, 80-81, 84-85, 107, 121

major depressive disorder, 16, 106, 118-119, 121

models of care, 176, 207-208, 210

pharmacologic interventions, 38, 39, 42-43, 44-45, 46-47, 86, 95, 105, 107, 118, 119, 120, 121

prevalence, 16, 106

psychodynamic therapy, 66-67, 68-69, 70-71, 121

psychotherapy, 50, 58-59, 60-61, 62-63, 107, 113, 121

St. John’s wort treatment, 82-83

suicide and suicidal ideation, 106, 107, 116, 118-119

symptoms, 106-107

Disability compensation for undiagnosed illnesses, 23, 166-167

Dissemination of information on CMI, 3, 7-8, 171, 174, 183, 188-190

DocCom, 145

Doxycycline, 38, 39, 40, 41, 42-43, 184

Duloxetine, 38, 95, 120

E

Education (see Patient education; Training of clinicians)

Electroconvulsive therapy, 107, 121

Electronic health records (EHRs), 5, 134, 146, 147, 163-164, 176, 186

Enhanced medical care (EMC), 52, 66-67

Escitalopram, 39, 40, 41, 46-47

Exercise

aerobic, 9, 46-47, 60-61, 68-69, 79, 84-85, 95, 120, 159

anxiety, 77, 80-81, 84-85

chronic fatigue syndrome, 99

chronic pain, 84-85, 99, 116, 120, 158

cognitive behavioral therapy plus, 38, 50-51, 60-61, 79, 84-85, 95, 99, 120, 159, 169, 184

depression, 77, 80-81, 84-85, 107, 121

effectiveness, 79, 84-85

fibromyalgia, 95, 120

Gulf War Veterans’ Illnesses, 60-61, 84-85

research needs, 9, 191

sleep disorders, 102

somatic symptom disorders, 46-47, 53, 68-69, 77, 78, 80-81, 84-85

strength of evidence, 79, 84

substance-use disorders, 116, 122

Eye movement desensitization and reprocessing (EMDR), 54, 70-71

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

F

Family support, 116

Fibromyalgia
biofeedback intervention, 66-67

cause, 94, 203, 205

clinician–patient communication, 140

and CMI, 1, 4, 18, 23, 29, 32, 94, 97

cognitive behavioral therapy, 54, 68-69, 95, 120

comorbid conditions, 104

diagnostic criteria, 22, 23, 94

exercise therapy, 95, 120

multimodal therapy, 95, 120

pharmacologic interventions, 33, 38, 40, 94-95, 119, 120

prevalence, 94

symptoms, 3, 22, 94

Functional dyspepsia, 4, 102-103, 104, 105, 121, 185, 204

Functional gastrointestinal disorders (see also Functional dyspepsia; Irritable bowel syndrome)

and CMI, 102-104

nonpharmacologic treatments, 105-106

pharmacologic treatments, 105

G

Gabapentin, 38, 95, 120

Gulf War syndrome, 22

Gulf War veteran population defined, 1 n.1

prevalence of CMI, 2, 24-26

Gulf War Veterans’ Illnesses, 22, 40, 60-61, 84-85

H

HEROES study, 26

Hypervigilance, 25, 105, 109, 110, 205

Hypnosis, 46-47, 68-69, 72, 106, 121

Hypochondriasis, 50, 60-61, 68-69

I

Image rehearsal therapy, 102, 121

Institute for Healthcare Communication, 145

Institute for Healthcare Improvement, 170

Institute of Medicine (IOM), 2-3, 9, 12, 13, 14, 15, 22, 30, 113, 191

Integrated Disability Evaluation System (IDES), 166, 167

International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health, 112

International Society for Traumatic Stress Studies Guidelines, 111

Iraqi War veterans, defined, 1 n.1

Irritable bowel syndrome (IBS) cause, 203, 204

clinician–patient communication, 140, 210

and CMI, 1, 3, 18, 22, 23, 29, 97, 103-104, 185, 205

diagnosis, 23, 103, 203

hypnosis and, 106

pharmacologic treatments, 105, 119

prevalence, 103

psychodynamic interventions, 53-54, 66-67

psychotherapy, 54, 68-69, 105-106

symptoms, 103, 104, 204

treatments, 4, 33, 53-54, 66-67, 68-69, 104, 105-106, 119, 121

Irritable colon syndrome, 50

Irritable heart, 11, 22

J

Jungian therapy, 52, 64

K

Kampo, 76, 77, 78, 82-83

L

Learning networks, 7-8, 149, 170, 175, 189

Levosulpiride, 40, 41, 42-43

M

Management of care (see Patient-centered care for CMI)

Methadone, 115, 122

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

Methods of review

comorbid conditions with shared symptoms, 32-34

current research, 35

data abstraction and assessment, 32

generalizability of studies, 4, 39, 86, 184

health outcomes assessed, 15

information sources, 29-30, 32-35

public meetings and social media review, 32-35

selection of evidence, 31

summary of literature search and study selection process, 31-32, 33

systematic review of treatments, 30-32

Mind–body approached (see Biofeedback; Cognitive rehabilitation therapy; Complementary and alternative medicine)

Mirtazapine, 39, 42-43

Models of care (see also Department of Veterans Affairs Health Care System)

civilian settings, 173

clinician behavior change, 175-176

committee approach, 3

depression, 176, 207-208, 210

disseminating evidence-based guidelines, 173-175

implementation of changes, 171-173, 174

organization of services for veterans with CMI, 167-173

PACTs, 5-6, 7, 9, 157-158, 167-170, 187, 188, 189, 191

Plan Do Study Act (PDSA), 170-171, 172

postseparation comprehensive health assessment, 167-169

Monoamine oxidase inhibitors, 38

Motivational interviewing (MI), 9, 115, 138-139, 191

Movement therapies, 63, 76-77, 78

Myalgic encephalomyelitis (see Chronic fatigue syndrome)

N

Naltrexone, 35, 115, 122

National Collaborating Center for Primary Care, 108

National Institute for Health and Clinical Excellence, 108

Nefazodone, 39, 40, 41, 44-45

Nonsteroidal anti-inflammatory drugs, 38, 96, 99, 120

O

Operation Desert Storm, 1 n.1, 15

Operation Enduring Freedom, 1 n.1, 15, 25

Operation Iraqi Freedom, 1 n.1, 15, 25

Operation New Dawn, 1 n.1, 15, 25

Opioid analgesics, 25, 38, 96, 114, 115, 116, 120, 122

Opipramol, 39, 40, 41, 46-47

P

Pain (see Chronic pain)

Paroxetine, 39, 40, 41, 44-45

Patient-aligned care teams (PACTs), 5-6, 7, 9, 157-158, 167-170, 187, 188, 189, 191

Patient-centered care for CMI (see also Patient–clinician relationship)

consultations with mental health experts, 12, 135-136

coordination of care, 5, 7, 8, 12, 96, 107, 159, 161, 168, 169, 186, 187, 188, 189-190

information and communication technologies, 146-149

rationale for, 17

training of clinicians, 7, 8, 47, 69, 79, 133-136, 138, 145, 149, 160, 161, 162, 170, 188-190, 207-210

VHA Office of Patient Centered Care and Cultural Transformation, 160

Patient–clinician relationship

communication skills, 7, 8, 136-137, 138-139, 140, 207-210

determinants of good interactions, 138-139

patient perceptions of, 137-138

recommendations for improving, 139-145

resources for clinicians, 145

Patient education Internet and social media use, 17, 147

pain management, 158

substance-use disorders, 116

VHA-provided materials, 158

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

Patient experiences of care, 6, 16-17, 32, 59, 136, 143, 161-162, 187, 190

Patient satisfaction, 161-162

Persian Gulf War Veterans Act of 1998, 12

Pharmacologic interventions (see also specific agents)

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

chronic pain, 42-43, 44-45, 95, 96, 99, 105, 114, 116, 119, 120, 210

depression, 38, 39, 42-43, 44-45, 46-47, 86, 95, 105, 107, 118, 119, 120, 121

effectiveness, 42-48

fibromyalgia, 33, 40, 94-95, 119, 120

functional gastrointestinal disorders, 105, 119

PTSD, 102, 111, 119, 121

sleep disorders, 95, 99, 102, 105, 120, 121

somatic symptom disorders, 39, 40, 42-47, 53, 72, 74-75, 101, 119, 120

strength of evidence, 41

substance-use disorders, 115, 122

traumatic brain injury, 113

Posttraumatic stress disorder (PTSD) clinical practice guidelines, 111, 158

and CMI, 4, 11, 26, 32, 109-111, 185

cognitive behavioral therapy, 50, 111, 121

comorbidities, 96, 101, 102, 104, 109, 186

complementary and alternative medicine, 111

diagnostic criteria, 109, 110

patient–clinician communication, 144

pharmacotherapy, 102, 111, 119, 121

post-Vietnam syndrome, 22

prevalence, 16, 25, 110

screening tools, 109

Prazosin, 102, 121

Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 9, 191

Pregabalin, 38, 95, 96, 120

Psychiatric consultation, 56-57, 135

Psychodynamic interpersonal therapy (PIT), 53, 66-67, 106, 107, 119, 121, 122

Psychodynamic psychologic interventions anxiety, 52, 53, 54, 64-65, 66-67, 108, 121

biopsychosocial intervention, 64-65

cognitive behavioral therapy with, 52

depression, 66-67, 68-69, 70-71, 121

dynamic psychotherapy, 64-65

group, 53, 55, 64-65

individual, 52-53, 55

outcomes and results, 64-67

somatic symptom disorders, 52-53, 54, 64-65, 66-67

strength of evidence, 55

studies, 51

Psychotherapies (see also Cognitive behavioral therapy; Psychodynamic psychologic interventions)

anxiety, 50, 51, 58-59, 60-61, 62-63, 108, 113, 120, 121

chronic pain, 64-65

reviews, 53-54

strength of evidence, 55

for substance-use disorders, 115-116

summary of, 54-56

systematic reviews, 66-71

Pyridostigmine bromide, 13

Q

Quick Start program, 166

R

Radioelectric asymmetric conveyer brain stimulation (REAC-BS), 40-41, 48-49

Radiofrequency ablation of branch nerves, 96, 120

Reattribution training, 69, 135

Recommendations (see also Research recommendations)

data collection and quality improvements, 8, 190

dissemination of information, 7-8, 188-190

improving care, 5-7, 186-188

treatments for CMI, 4-5, 183-185

Relaxation interventions, 41, 49, 51, 57, 60-61, 66-67, 72, 74-75, 100, 102, 106, 108, 120-121

Research recommendations evaluation of programs, 9, 191-192

treatments for CMI, 8-9, 191

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

S

Selective serotonin reuptake inhibitors (SSRIs), 4, 38, 105, 107, 111, 118, 119, 120, 121, 185

Self-harm

and CMI, 4, 32, 117-118

screening measures, 116-117

treatments, 118-119

Serotonin–norepinephrine reuptake inhibitors (SNRIs), 4, 38, 95, 96, 105, 108, 119, 120, 121, 185

Shell shock, 11, 22

Sleep disorders

acupuncture, 102

circadian-rhythm sleep disorders, 101-102

and CMI, 4, 16, 21, 25-26, 101-102, 107, 159, 185

cognitive behavioral therapy, 49, 102, 121

comorbidities, 32, 94, 97, 98, 99, 101, 102, 105, 106, 107, 109, 120, 205

continuous positive airway pressure, 99, 120

exercise therapy, 102

insomnia, 98, 101, 102, 106, 121

mind–body approaches, 102

nightmare disorder, 101, 102

obstructive sleep apnea, 101

pharmacological treatments, 95, 99, 102, 105, 120, 121

prevalence, 16, 24, 25

rapid eye movement (REM) sleep behavior disorder, 101, 205

relaxation therapies, 60-61, 100, 121

symptoms, 100

treatments, 99, 102

Sleep hygiene, 49, 99-100, 102, 120

Social media use, 3, 34, 137, 146, 147, 148, 149

Somatic symptom disorders, 100

biofeedback, 57, 72-73, 74-75, 101, 120

and CMI, 4, 22, 32, 97, 99, 101, 185, 203, 204, 205

cognitive behavioral therapy, 41, 46-47, 50, 51, 53, 56-59, 62-63, 68-69, 70-71, 72, 108, 113, 120, 184

comorbidities, 104, 106, 110

diagnosis, 16, 22, 72

exercise interventions, 46-47, 53, 68-69, 77, 78, 80-81, 84-85

hypersensitivity, 205

hypnosis, 72

Kampo, 77, 78

pharmacologic treatments, 39, 40, 42-47, 53, 72, 74-75, 101, 119, 120

psychodynamic psychotherapies, 52-53, 54, 64-65, 66-67

relaxation interventions, 41, 49, 51, 57, 60-61, 66-67, 72, 74-75, 100, 102, 106, 108, 120-121

St. John’s wort, 77-78, 80-81, 82-83, 184-185

subthreshold, 72

suicide risk, 117

terminology, 100

Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) programs, 4, 6, 7, 9, 159-160, 185, 187, 189, 191

St. John’s wort supplement, 9, 76, 77-78, 80-81, 82-83, 184, 191

Stimulus-control therapy, 102, 121

Substance-use disorders behavioral couples therapy, 115, 122

clinician resources, 145

and CMI, 4, 25, 32, 114, 185

cognitive behavioral therapy, 115, 122

comorbidities, 101, 109, 114

diagnostic criteria, 113-114

exercise programs, 116, 122

family support, 116

motivational interviewing, 138

opioid pain management therapy and, 114, 116, 122

patient education, 116

pharmacologic treatments, 115, 122

psychotherapy, 115-116

Suicide and suicidal ideation, 106, 107, 116, 118-119

Sulpiride, 39

T

Tai Chi, 63, 100, 120

Topiramate, 38, 39, 40, 41, 42-43, 115, 122

Toxic exposures, 12, 13

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
×

Training of clinicians, 7, 8, 47, 69, 79, 133-136, 138, 145, 149, 160, 161, 162, 170, 188-190, 207-210

Tramadol, 38, 95, 96

Transcutaneous electric nerve stimulation, 96-97, 120

Traumatic brain injury, 111-113

access to care, 173

clinical practice guidelines, 158

and CMI, 4, 32, 112, 185

cognitive behavioral therapy, 121

cognitive rehabilitation therapy, 113

comorbidities, 16, 109, 186

defined, 111-112

pharmacologic treatments, 113

prevalence, 16, 25, 96, 112

treatments, 113

stratification of severity, 112

symptoms, 93, 112

Treatments for CMI (see also individual treatment approaches)

adherence to, 43, 50-51, 52, 61, 79, 105, 116, 136, 138, 139, 141

general approach for medically unexplained physical symptoms, 12

multimodal approaches, 4, 9, 95, 96-97, 122, 185, 191

research recommendations, 8-9, 191

Tricyclic medications, 38, 95, 96, 105, 119, 120, 121, 185

U

US Food and Drug Administration (FDA), 95

UK National Health Service, 97

UK National Institute of Health and Clinical Excellence Guideline, 111, 118-119

University of New Mexico Health System, 148

V

Varenicline, 115, 122

Venlafaxine, 39, 40, 41, 42-43, 44-45, 101, 120

Veterans Benefits Act of 2010, 2, 13

Veterans Programs Enhancement Act of 1998, 12

W

War-Related Illness and Injury Study Centers (WRIISC), 4, 6, 7, 9, 160, 169, 173, 185, 188, 190, 191

Y

Yoga, 76, 100, 120

Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
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Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
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Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
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Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
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Suggested Citation:"Index." Institute of Medicine. 2013. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academies Press. doi: 10.17226/13539.
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Gulf War and Health: Treatment for Chronic Multisymptom Illness Get This Book
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Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories—fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic—that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well.

In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review.

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