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Treatment for Gulf War Illness Works
March 18, 2003 -- For the first time, a treatment appears to help veterans suffering from Gulf War veterans illness, GWVI.
The treatment is cognitive behavioral therapy, CBT, combined with aerobic exercise. In the largest clinical trial of its kind, researchers found that these treatments helped a significant number of patients with GWVI -- previously known as Gulf War syndrome.
Overall, the effects were rather modest. Fewer than 1 in 5 veterans responded to CBT plus exercise or to CBT alone. But there are signs that in the real world, the treatment may be more effective than in the trial. It's already being promoted for GWVI patients, says Nelda P. Wray, MD, MPH, chief research and development officer for the Department of Veterans Affairs.
"The number of people responding was not high," Wray tells WebMD. "But these were the sickest of the sick. ... Patients on average only went to 50% of therapy sessions, and response to treatment was directly related to how many sessions a person attended. So we believe the response will be greater in everyday practice than it was in this trial. We are taking positive action to ensure that the 200-plus doctors treating GWVI in the VA are aware of this study and make this treatment available."
The study appears in the March 19 issue of The Journal of the American Medical Association and was presented as a meeting of rheumatology specialists in October 2002(see "Talk Therapy Helps Gulf War Illness").
Just because a nondrug treatment helps GWVI patients doesn't mean the illness is all in their heads, says study leader Daniel J. Clauw, MD, director of the University of Michigan's chronic pain and fatigue research group and a researcher at the Ann Arbor VA.
"This is very different from psychotherapy," Clauw tells WebMD. "Nothing here is aimed at depression or anxiety. There's no probing to see how they feel or what happened to them in childhood. These are not components of CBT. And CBT has been shown to improve outcomes in a whole variety of medical illnesses. It improves survival after heart attack; it improves airflow in asthma sufferers. CBT programs are used in a lot of illnesses not seen as psychological in nature. It is unfortunate there's a perception that CBT is equivalent to psychotherapy -- it isn't."
Veterans with GWVI often suffer debilitating symptoms. There's never been an effective treatment. Part of the problem is that nobody knows exactly what causes the illness. And different patients have different symptoms. These include long-lasting fatigue, pain, trouble thinking, sleep difficulties, and other problems.
There is, however, a clue. GWVI isn't the first time doctors have seen unexplained symptoms like this. When it happens to people who aren't Gulf War veterans, it's called fibromyalgia or chronic fatigue syndrome. There's no cure for these conditions -- but lots of patients respond to cognitive behavioral therapy and physical exercise. Now the trial -- which enrolled 1,092 seriously ill Gulf War veterans -- shows that it can work for GWVI, too.
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