A majority of veterans returning home from Iraq and Afghanistan are reporting symptoms of a condition known as chronic multisymptom illness (CMI), according to a new Veterans Affairs study of more than 300 enlisted Army National Guard and Army Reserve troops. The data was collected one year after their return.
The condition presents itself as a combination of chronic symptoms, including memory problems, insomnia, fatigue, headache, dizziness, joint pain, indigestion, and breathing problems.
“As a whole, CMI can be challenging to evaluate and manage,” said lead author Dr. Lisa McAndrew from the University at Albany. “CMI is distinct from PTSD or depression. It contributes to significant disability.”
CMI has previously been associated with service during the Persian Gulf War in the early 1990s with at least a quarter of those veterans affected.
Experts are unsure, however, if that condition is the same one that is emerging with such force among recent veterans. Last year, for example, researchers with the Millennium Cohort Study reported that about one-third of combat veterans who served in Iraq and Afghanistan had CMI symptoms.
“This condition appears to be similar to that experienced by many Gulf War veterans, in terms of the symptoms, but we don’t really know if it’s the same condition,” says McAndrew. “That still requires study.”
For the new study, the researchers surveyed 319 soldiers about their overall health before they deployed and one year after they returned. The findings show there were 150 soldiers who did not report many symptoms before they deployed but who reported symptoms of CMI one year after deployment, suggesting a link between deployment to Iraq or Afghanistan and CMI.
Overall, nearly 50 percent of the overall group met the criteria for mild to moderate CMI, and about 11 percent met the criteria for severe CMI, one year after deployment.
The most common symptoms reported were trouble sleeping, moodiness or irritability, joint pain, fatigue, difficulty remembering or concentrating, headaches, and sinus congestion.
Not surprisingly, veterans who screened positive for CMI scored significantly lower on measures of physical and mental health function.
In total, 166 of the veterans suffered from chronic pain, lasting more than three months. Almost all of those with chronic pain — 90 percent — also met the criteria for CMI. Similarly, 82 percent of those with CMI reported chronic pain. The finding underscores the strong link between chronic pain and CMI, say the researchers.
Furthermore, nearly every veteran with PTSD symptoms also showed signs of CMI — about 98 percent. Only seven patients had PTSD and did not meet the criteria for CMI. In contrast, though, about 44 percent of the veterans with CMI did not have PTSD. In other words, the link between PTSD and CMI was not as robust as that between chronic pain and CMI.
The authors caution that the study looked only at pain and PTSD as factors associated with CMI. It did not document other conditions that could possibly account for CMI symptoms, such as depression, traumatic brain injury, or substance abuse. However, they say that these other conditions are unlikely to completely account for the frequency of symptoms seen in the study.
All in all, the research team advises that the results be interpreted with caution.
“We’re taking the approach that an abundance of caution is necessary in the clinical implications of the findings. Respondents self-reported symptoms on pen and paper surveys. The symptoms were not confirmed or evaluated by a clinician,” says McAndrew.
“While the CDC case definition is fairly clear-cut, in clinical practice there is a lot of gray area around applying the label of CMI. We used the term ‘symptoms consistent with CMI’ to indicate the uncertainty due to the self-reported, clinician-unverified nature of the classification.”
McAndrew’s group says clinicians should consider CMI when evaluating Iraq and Afghanistan Veterans, especially those with chronic pain. Once the condition is identified, clinicians in VA and the Department of Defense do have a clinical practice guideline for managing the condition.
“Acknowledging the presence of multiple symptoms and taking a holistic approach to achieving patient goals is critical in managing CMI,” says McAndrew.
The WRIISC study notwithstanding, McAndrew says not enough attention has been focused on the issue to date.
“There have been few studies of CMI among Iraq and Afghanistan veterans. Our findings suggest this could be an overlooked problem.”
The findings are published in the Journal of Rehabilitation Research and Development.