Tag: veterans

Post-Exertional Malaise in Veterans with Gulf War Illness

Abstract:

Post-exertional malaise (PEM) is a potentially debilitating aspect of Gulf War Illness (GWI) that has received limited research attention. The purpose of the present investigation was to determine symptom severity changes following exercise in Veterans with GWI compared to control Veterans without GWI (CO).

Sixty-seven Veterans (n=39 GWI; n=28 CO) underwent a 30-minute submaximal exercise challenge at 70% of heart rate reserve. Symptom measurements (e.g. fatigue, pain) occurred pre-, immediately post-, and 24-hours post-exercise. Self-reported physical and mental health, and physiological and perceptual responses to exercise were compared between groups using descriptive statistics, independent samples t-tests and repeated measures Analysis of Variance (RM-ANOVA).

Post-exertional malaise was modeled using Group by Time (2 × 3) doubly-multivariate, RM-MANOVAs for (1) mood, (2) pain and (3) GWI-related symptoms, respectively (α=0.05). Data were analyzed for the full sample of Veterans with GWI (n=39) compared to CO (n=28) and a subsample of Veterans (n=18) who endorsed “feeling unwell after physical exercise or exertion” (“PEM endorsers”) during screening.

Veterans with GWI reported significantly lower physical and mental health. Groups exercised at similar relative exercise intensities, but GWI perceived exercise as more painful and fatiguing. Group-by-Time interactions were not significant for the entire sample for the three PEM models, however limiting the GWI sample to “PEM endorsers” resulted in significant interactions for Pain- and GWI-related PEM models.

These results indicate that not all GVs with GWI experience PEM 24 hr after exercise, and that more research is needed to determine the extent that exercise worsens symptoms in GWI.

Source: Lindheimer JB, Stegner AJ, Wylie GR, Klein-Adams JC, Almassi NE, Ninneman JV, Van Riper SM, Dougherty RJ, Falvo MJ, Cook DB. Post-exertional malaise in veterans with gulf war illness. Int J Psychophysiol. 2020 Jan;147:202-212. doi: 10.1016/j.ijpsycho.2019.11.008. Epub 2019 Nov 28. PMID: 31786249; PMCID: PMC6957714. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957714/ (Full text)

A population-based investigation into the prevalence of chronic fatigue syndrome in United States military Veterans with chronic pain

Abstract:

Objective: Chronic fatigue syndrome (CFS) is a debilitating illness characterized by persistent fatigue among other symptoms. Pain symptoms are common and included in the diagnostic criteria for CFS but are not required for diagnosis. Despite the association between CFS and pain, few studies have examined CFS in the context of chronic pain (CP) conditions. The current study estimates the period prevalence of comorbid CFS among military Veterans with CP and compares sociodemographic characteristics and CP conditions of Veterans with CP + CFS to those with CP without CFS.

Methods: This study included Veterans Health Administration (VHA) data on 2,261,030 patients with chronic pain in 2018. Sociodemographic characteristics included age, sex, race, ethnicity, and rurality. Descriptive statistics were used to describe the sample and between-group comparisons included independent samples t-tests and chi-square tests of independence. Effect sizes were also examined.

Results: A total of 15,248 (0.67%) of Veterans with CP also had a diagnosis of CFS. Veterans diagnosed with CP + CFS were younger and were more likely to be female, White, non-Hispanic, and rural-dwelling. However, small and weak effect sizes were observed for these differences. The majority of Veterans with CP + CFS had limb/extremity (69.20%) back pain (53.44%), or abdominal/bowel pain (24.11%).

Conclusion: CDC treatment recommendations for CFS include treating pain first, studying CFS in the context of CP is critically important. Veterans diagnosed with CP + CFS appear demographically similar, compared to Veterans with CP without CFS. Examining the utilization of pain-related healthcare services among this group would be a useful next step.

Source: Jenna L. Adamowicz, Emily B. K. Thomas, Brian C. Lund, Mary A. Driscoll, Mark Vander Weg & Katherine Hadlandsmyth (2023) A population-based investigation into the prevalence of chronic fatigue syndrome in United States military Veterans with chronic pain, Fatigue: Biomedicine, Health & Behavior, DOI: 10.1080/21641846.2023.2239977

Symptoms and signs of dry eye in US veterans with Myalgic encephalomyelitis/chronic fatigue syndrome

Abstract:

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is clinically defined as persistent and unexplainable post-exertional fatigue and can present with a wide range of cognitive, immunological, endocrinological, and autonomic symptoms. A notable feature of ME/CFS is its comorbidity with pain in multiple compartments. In this study, we examine ocular manifestations associated with ME/CFS, with a focus on ocular surface pain complaints.

Methods: We recruited 124 United States veterans and profiled them for symptoms and signs of dry eye (DE). Individuals were grouped by the presence (n=42) and absence (n=82) of ME/CFS.

Results: The mean age of the population was 55.49 ± 4.61 years, 88.7% of participants identified as male, 58.1% as White, and 39.5% as Hispanic. Demographics, medical comorbidities, and medication use were similar between groups except for depression (57.1% vs. 29.6%, p=0.003), and history of traumatic brain injury (9.5% vs. 1.2%, p=0.03) which were more prevalent in the ME/CFS group. Individuals with ME/CFS reported higher ocular surface pain complaints, both through DE specific questionnaires (Ocular Surface Disease Index, OSDI; 5-Item DE Questionnaire, DEQ-5) and pain specific questionnaires (Neuropathic Pain Symptom Inventory, modified for the Eye, NPSI-E; Numerical rating scale, NRS) (Table 1). Ocular surface parameters were similar between groups, except for persistent pain after topical anesthesia which was more frequent in the ME/CFS group (Table 2).

Conclusions: Individuals who met criteria for ME/CFS had more severe ocular surface pain, but similar signs of DE, compared to controls. This suggests that nerve, and not tear, abnormalities contribute to ocular surface pain in ME/CFS.

Source: Victor Sanchez; Colin Kim; Kimberly Cabrera; Elyana Vittoria Tessa Locatelli; Molly Johnson; Anat Galor. Symptoms and signs of dry eye in US veterans with Myalgic encephalomyelitis/chronic fatigue syndrome. Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3978. https://iovs.arvojournals.org/article.aspx?articleid=2790532