Post-war syndromes found to be ‘remarkably similar from conflict to conflict’

Daniel J. Clauw Photo: D.C. Goings

After World War I, it was shell shock. After World War II, people called it soldier’s heart. The Vietnam War brought us post-traumatic stress disorder. And in the early 1990s after Desert Storm, everyone was talking about Gulf War syndrome.

The names may be different, but the phenomenon is the same: Shortly after returning from military service, war veterans begin showing up in doctors’ offices with similar complaints of generalized body aches and pain, severe fatigue, memory difficulties and mood disturbances — all with no apparent cause.

“Military historians reviewed the medical records of war veterans and found that symptoms are remarkably similar from conflict to conflict,” says Daniel J. Clauw, M.D., director of the U-M’s Chronic Pain and Fatigue Research Program and a professor of internal medicine-rheumatology in the Medical School. Funded by the U.S. Department of Defense, 20 U-M faculty researchers affiliated with the program study mechanisms and effective treatments for chronic stress-related illness.

“After every war, we invent a different syndrome and try to explain it in the context of that particular war,” Clauw says. “After the Vietnam War, everything that happened to some of the soldiers was blamed on exposure to Agent Orange. After Gulf War I, we spent $220 million on research trying to link toxic emissions from burning oil wells to veterans’ health problems.”

Instead of wasting time, money and effort on what he calls the “evil toxin” theory, Clauw hopes to help veterans and physicians understand that multi-focal pain, incapacitating fatigue and memory or mood changes are part of the body’s normal reaction to severe physical and emotional stress. Clauw and others in the U-M program have developed a public Web site, called “Gulf War Health: Coming Home From War,” to provide information for veterans, their families and health care providers on what to expect and how to manage the post-war adjustment period.

“The Web site tells veterans that it is natural to feel out of place or tired, because they have been through an incredibly stressful experience,” Clauw says. “Now they are returning to a family that is different than it was six months ago. The site describes some of the symptoms they may experience, which are entirely normal, and gives people things they can do to make it less likely these symptoms will continue.”

Too many people underestimate the damage stress can do to the human mind and body. But after 16 years of studying stress-related illnesses like fibromyalgia, chronic fatigue syndrome or irritable bowel syndrome, Clauw knows how dangerous stress can be — especially when people are exposed simultaneously to many types of acute stress, such as from physical trauma, infection, intense emotions, and exposure to drugs or chemicals.

“Current research data suggests that people returning from war with medically unexplained symptoms have the same problems physicians see commonly in the general population,” says Clauw. “Although some people with these conditions develop psychological issues, these are not primarily psychiatric illnesses. There are real abnormalities in how the brain works in people with this type of illness.”

One of the most important research discoveries about stress-related illnesses is that it is possible to prevent them from developing into a chronic condition, which is much more difficult to treat successfully. “You have a window of about three to four months where, if you can restore normalcy as much as possible, it is far less likely the symptoms will become chronic,” Clauw says.

“Our goal is to prevent future post-war illnesses by giving people simple things to do to prevent the condition from becoming chronic,” Clauw says. “It is very important that veterans resume rapidly their normal pre-deployment routines of work, sleep, exercise and leisure activity and re-connect with their families and social support network. The worst thing you can do for this spectrum of illness is tell people they are going to become chronically ill.”

—SFP

See the “Gulf War Health: Coming Home From War” Web site:
www.med.umich.edu/gulfwarhealth

More information about the U-M Chronic Pain and Fatigue Research Program:
www.med.umich.edu/painresearch