Regarding Gulf War Syndrome

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Unexplained musculoskeletal pain, fatigue, and sleep problems have been observed after every military conflict as far back as the Civil War. To date, researchers haven't been able to identify any specific environmental agent as the cause or the trigger of the particular symptoms experienced by the veterans. The one thing they do all have in common is the stress that occurs during war times. It is likely that this stress is responsible for their medical problems.

After the Gulf War in 1991, similar to many other military campaigns throughout history, as many as half of the military people who had served in the Persian Gulf reported suffering from symptoms of muscle pain, headaches, difficulty with memory, and fatigue. Among their military compatriots who did not serve in the Gulf War region during the same time frame, only about 15 percent reported similar complaints. In retrospect, many of the veterans' complaints, also generically known as Gulf War syndrome, may have been consistent with a diagnosis of fibromyalgia. However, despite intensive research, no one could find any specific toxins, like nerve gas, that would explain the Gulf veterans' symptoms.

Female veterans and PTSD

A survey of 1,259 female veterans who received care at a veterans' facility in Puget Sound, Washington, was reported in Archives of Internal Medicine in 2004. The researchers found that 21 percent of the women (266 women) were positive for PTSD. The women with PTSD were significantly more likely to have fibromyalgia, irritable bowel syndrome, chronic pelvic pain, premenstrual syndrome, obesity, and other health problems than were the female veterans without PTSD. For example, of the female veterans with PTSD, 19.2 percent had fibromyalgia, compared to 8 percent of the women veterans without PTSD.

Clearly, PTSD is a risk factor for fibromyalgia.

Some researchers have speculated that the military people who served in the Gulf during the war may have contracted a viral or bacterial infection that could have led to their symptoms, perhaps one that was further aggravated by the heightened stress of undergoing warfare in another country. Others think that the severe stress of a combat situation alone could have been sufficient to induce the medical problems that the veterans suffered from. Soldiers in combat have an increased risk of developing post-traumatic stress disorder (PTSD), which itself increases the risk for the development of fibromyalgia and other medical problems.

In one study of Gulf War veterans (104 men and 21 women) who complained of a variety of symptoms, the researchers at Oregon Health Sciences University in Portland, Oregon, found that 27 percent of the veterans met the diagnostic criteria for chronic fatigue syndrome and 14 percent met the diagnostic criteria for fibromyalgia.

In another study published in 2005 in the Annals of Internal Medicine, researchers compared the health of 1,061 individuals deployed to the Persian Gulf in 1991 to nondeployed people in the military after ten years. The goal was to determine if there were any long-term effects in deployed veterans versus nondeployed veterans. Although the risk for fibromyalgia was low, the researchers found that veterans who had been deployed to the Gulf were nearly twice as likely to have fibromyalgia (2 percent) than the nondeployed veterans (1.2 percent). They also found that the deployed veterans had an increased risk for chronic fatigue syndrome, skin rashes, and dyspepsia (chronic stomach upset).

What about veterans who have been deployed to Afghanistan or Iraq in the 21st century? It's too soon to tell, but it seems likely that at least some of these veterans will develop fibromyalgia, for many of the same reasons as seen with veterans of the Gulf War and other wars.

Homing in on hormonal changes in fibromyalgia

Researchers have found that military veterans with fibromyalgia have low levels of growth hormone, a hormone that works to repair muscle tissue. Some civilians diagnosed with fibromyalgia have been found to have similarly low levels of this same hormone.

Researchers say that stressful conditions can inhibit the production of growth hormones. (It's not only children who produce growth hormone. All through your life, some levels of growth hormone are produced by the body.) So, perhaps the military veterans who were in a state of heightened stress under war conditions produced less growth hormone, which then led to the development of fibromyalgia. This theory remains unproven, but it's an intriguing possible explanation for the higher-than-normal incidence of chronic pain and fatigue among the military veterans who have served in the Gulf War.

Helping Gulf War veterans

No one may be able to explain why veterans return from war with symptoms of chronic illnesses, but that doesn't mean that these veterans can't get help. Veterans who served in the Gulf and who have since been diagnosed with chronic illnesses — such as chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), or fibromyalgia — may be eligible, and should apply, for financial benefits that are available through the Veterans Administration (VA).

Congress passed a law in 1994 to cover military veterans with symptoms of medical problems, such as chronic fatigue syndrome and fibromyalgia, but many veterans were denied benefits. In January 2002, a law was passed to broaden the coverage to more veterans of the Gulf War. The application deadline for these benefits is September 30, 2011. About 3,200 veterans were approved for compensation prior to 2002. (For further information, contact the nearest Veterans Administration office; go to www1.va.gov/directory/ guide/home.asp to locate a VA facility near you.)

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