Gulf War Syndrome

As troops come home from Iraq, U-M experts advise vigilance for symptoms of 'Gulf War syndrome II'

Wartime stress may cause chronic pain, fatigue, distress, and other ills

New independent Web site aims to help service members, families, doctors

ANN ARBOR, MI - When they were fighting Saddam Hussein's army in the Iraqi desert earlier this year, American troops probably weren't thinking about their long-term health -- or anything but their immediate military goals and their own survival.

But now that those service members are starting to return home, the strain they faced under fire may start to catch up with them in more ways than they ever could have imagined. From aches and pains to rashes and memory gaps, the lingering effects of the intense stress of war may be taking a toll on their bodies and brains.

Will veterans of Operation Iraqi Freedom suffer a sequel to the "Gulf War syndrome" that still plagues tens of thousands of veterans of the first Iraqi conflict, over a decade ago? With the right help, they won't have to, say University of Michigan Health System experts.

In fact, scientists and doctors know more now than ever about why veterans of every conflict in American history have suffered some form of post-war syndrome, a cluster of vague but very real mental and physical symptoms that often affect them for life.

Theories about causes ranging from chemicals and bacteria to radiation and viruses have made the headlines after each war. But researchers are finding more evidence that the true culprit may be the only common elements of every soldier's, sailor's, airman's and Marine's wartime experience: life-threatening and violent situations, extraordinary living conditions, and strange surroundings.

In other words: stress. Stress so intense it can knock a person's brain and body chemistry off kilter, causing chronic disease if symptoms go untreated.

But, says the U-M Health System's Daniel Clauw, M.D., treatment needs to come in the first few months after symptoms start to appear -- which means that newly returned troops, and their families and doctors, need to be on the lookout now.

"If new veterans have common symptoms like pain in various parts of their body, fatigue and memory problems, then there are a number of things they can do to help manage those symptoms and make them less likely to become chronic," Clauw says.

Clauw and his colleagues at the U-M Chronic Pain and Fatigue Research Program have created an independent Web site to help returning Iraq war veterans fight their newest battle, against long-term effects of their combat service.

The Gulf War Health site, www.med.umich.edu/gulfwarhealth, is aimed at service members, their families and health care providers, to help them recognize and deal with symptoms.

"Because we know what happened after the first Gulf War, we're trying to educate the returning service members on what they can do to either help prevent these symptoms, or at least better understand them and get medical treatment," says Clauw, a rheumatologist who specializes in research and treatment on many multi-symptom illnesses, including fibromyalgia, chronic fatigue syndrome and Gulf War veterans' illness.

"We don't like to say we 'expect' returning service members to come back with health problems," Clauw continues, "but we know that after every war the United States has been involved in, going all the way back to the Civil War, there have been veterans who come back with new health problems. And so, we can reasonably expect that some of the people who return from this conflict will have these same types of problems."

The difference this time, he adds, is the growing knowledge of what stress can do to the body, and what can be done to keep those effects from becoming permanent.

Clauw and his colleagues, as well as other teams nationwide, have done research in recent years that supports the theory that some people suffer the long-term effects of stress more than others, though it's impossible to tell in advance which people they will be. Others may suffer short-term problems, and others may come through horrific experiences unscathed.

So, as a guide for all service members, their families and health care providers, the new U-M site offers information on the kinds of symptoms that might occur, the types of activities and therapies that may help ease them, and the history of war-related syndromes and knowledge on the lasting effects of stress.

The list of symptoms includes pain in specific areas such as the lower back and neck or "all over"; fatigue or lack of energy; mood difficulties such as depression or irritability; gastrointestinal problems such as diarrhea, gas or bloating; problems with memory or ability to concentrate; rashes and other skin conditions; and disturbed sleep and insomnia.

The simplest preventive step that service members can take -- and perhaps the most important -- is trying to restore a sense of normalcy to life as soon as possible after they return from the war, during the initial readjustment to civilian life, Clauw says.

"That includes the same level of exercise or activity that they were doing before the war, and re-establishing social ties and connections," he explains. "From our research, we know that all of those things seem to be extremely important, and that when they aren't done, people seem to have some of the longer-term health consequences."

If symptoms don't fade over time, Clauw and his colleagues have found, there may be options that service members can do for themselves, or that health care providers can recommend. These include a structured exercise program, better attention to "sleep hygiene" via good habits that encourage sleep, avoiding alcohol, memory-building tricks, stress management and relaxation techniques, medications, and "talk therapy" with a mental health professional.

Clauw helped lead a national study that was published in the Journal of the American Medical Association this spring, showing that veterans of the first Gulf War who had war-related illnesses had improvement in their symptoms if they exercised or took part in group cognitive