Treatments for Chronic Multisymptom Illness

The committee conducted a de novo systematic assessment of the evidence on treatments for symptoms associated with CMI. The committee also identified evidence-based guidelines and systematic reviews on treatments for related and comorbid conditions (fibromyalgia, chronic pain, CFS, somatic symptom disorders, sleep disorders, IBS, functional dyspepsia, depression, anxiety, posttraumatic stress disorder, traumatic brain injury, substance-use and addictive disorders, and self-harm) to determine whether any treatments found to be effective for one of these conditions may be beneficial for CMI. Both pharmacologic and nonpharmacologic treatments were assessed. Holistic and integrative treatment approaches were considered in addition to individual interventions.

Studies of treatments for the symptoms associated with CMI conducted in the 1991 Gulf War veteran population were included in the assessment, as were studies conducted in different populations who had a similar constellation of symptoms. The generalizability of studies of nonveterans to veterans is not known.

The best available evidence from studies of treatment for symptoms of CMI and related and comorbid conditions demonstrates that many veterans who have CMI may benefit from such medications as selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and cognitive behavioral therapy. On the basis of the evidence reviewed, the committee cannot recommend any specific therapy as a set treatment for veterans who have CMI. However, for the reasons outlined below, the committee believes that a “one-size-fits-all” approach is not effective for managing veterans who have CMI and that individualized health care management plans are necessary. The condition is complex and not well understood, and it will require more than simply treating veterans with a set protocol of interventions.

Recommendation 8-1. The Department of Veterans Affairs should implement a systemwide, integrated, multimodal, long-term management approach to manage veterans who have chronic multisymptom illness.

VA already has several programs—for example, postdeployment patient-aligned care teams (PD-PACTs), Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) programs, and the War-Related Illness and Injury Study Center (WRIISC) program— that could be used to effectively manage veterans who have CMI. However, the programs have not been consistently implemented through the VA



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