Acupuncture in the Treatment of Gulf War Illness

Gulf War Illness (GWI) is a complex, poorly understood illness characterized by many
symptoms, including fatigue after exertion, sleep and mood problems, difficulty
concentrating, difficulty thinking and finding words, and musculoskeletal pain. Individuals
often present with many symptoms, some of them severe and disabling, and with additional
medical diagnoses, including chronic fatigue syndrome, fibromyalgia, irritable bowel
syndrome, digestive complaints, and mood-related psychiatric disorders, such as depression,
posttraumatic stress disorder, and other anxiety disorders. More than 100,000 veterans of
the first Gulf War (Operation Desert Shield/Storm, 1990-1991) out of 700,000 US service
personnel deployed to the Persian Gulf have presented with medical complaints through
programs established to address the problem, which came to be called chronic multisymptom
illness (CMI). Groups of veterans in the United Kingdom, Canada, and Australia were
identified with similar problems. The veterans have received treatment directed at their
symptoms, but at 5- and 10-year follow-ups, many reported their symptoms remained, some of
them severe and disabling. Clearly, an effective treatment for these conditions would be of
great benefit to those who were injured during their military service.

The cause of CMI is unknown, and the symptoms can not be explained by physical and
laboratory examinations. Several factors have been considered, including exposure to
vaccines, chemicals likely to be encountered in combat (chemical weapons, smoke, pesticides)
and stress related to military service, deployment, and combat. After investigation by the
Centers for Disease Control (CDCP), researchers suspect that the symptoms reflect a range of
injuries to the nervous system. It may be that the factors that led to these injuries were
not specific to the Persian Gulf region, and that veterans of the current war in Iraq and
Afghanistan, as well as active duty personnel, are exposed to similar stressors and will
benefit from an investigation of CMI and its treatment.

The goal of this study is to help identify whether acupuncture is an effective treatment for
Gulf War Syndrome. Acupuncture is likely to be helpful in treating GWI because it has
already been used successfully to reduce many of its key symptoms - fatigue, irritability,
anxiety, insomnia, and pain. Acupuncture treatment is designed to treat each individual's
symptoms making it very well suited for treating the varied symptoms of GWI. Veterans will
receive care that is directed specifically at their most distressing symptom. Though the
specific etiology of CMI is unknown, acupuncture's analgesic and anti-inflammatory effects
are likely to be helpful. Acupuncture seems to work, in part, on peripheral nerves near the
site of injury, in the brain, central nervous system, and on the endocrine system, in ways
that promote the body's own efforts to reduce pain and heal even chronic injuries. Numerous
studies have shown acupuncture is well tolerated by patients, safe, and cost-effective
compared to routine care. Acupuncture will be provided by licensed acupuncturists with at
least 5 years of clinical experience, who have received 20-hours of training related to
symptoms of GWI.

The investigators plan to recruit patients through the Department of Veterans Affairs (VA)
who report they have symptoms of GWI. Through questionnaires, physician assessment and
medical histories, the investigators will measure the severity of symptoms before beginning
treatment, after 2 months, and after treatment is completed. One group of patients will
receive acupuncture evaluation and treatment twice per week for 2 months, followed by once
per week for 4 months. A second group, for comparison purposes, will continue whatever
treatment they received from their physicians, and will be offered acupuncture after waiting
for 2 months. Based on previous acupuncture research on fatigue, stress, and pain, the
investigators expect this length of treatment will be enough for patients to receive
significant benefit. The investigators also plan to collect samples of blood and saliva from
our volunteers that will help identify possible disease mechanisms for the illness and track
the effects of treatment.